Archived Health Updates

4/15/16

Vitamin D

By coincidence, I somehow have a few friends very high up in the American Academy of Pediatrics. I either went to medical school or undergrad with them or worked with them in another organization. I have had communications with a couple of them before about their lack of discussion about the EMF (electromagnetic field) dangers in much of today’s technology especially as it relates to kids. Recently, another big wig friend posted this recommendation given by both the AAP and the NIH . It is about Vitamin D and it is an absolute dud. See if you can find what is missing:

Vitamin D: On the Double

If you think your child is getting enough vitamin D by just drinking milk, you’re probably wrong. Recent studies show that most children aren’t getting enough of this essential vitamin. In October 2008, the American Academy of Pediatrics (AAP) responded by doubling the amount of vitamin D it recommends for babies and children to 400 International Units (IU) per day.

Why Vitamin D?
Most often associated with milk and sunlight, vitamin D hasn’t been top-of-mind for parents in recent years. Common wisdom says that if you’re child drinks milk and plays outside, he’s getting what he needs, right? Surprisingly, not necessarily. “We’re seeing evidence of vitamin D deficiency in infants and children of all ages as well as adolescents and adults,” says Carol Wagner, M.D., FAAP, professor of pediatrics at the Medical University of South Carolina. “We know more about vitamin D than we did even five years ago. Because of lifestyle changes and sunscreen usage, the majority of the population shows signs of deficiency as determined by measured vitamin D levels in blood.”

Vitamin D helps ensure the body absorbs and retains calcium and phosphorus, both critical for building bone. A vitamin D deficiency can lead to rickets, a bone-softening disease that continues to be reported in the United States mostly in children in the first two years of life. At greatest risk for rickets are infants exclusively breastfed who do not receive a daily vitamin D supplement.

“There is epidemiologic evidence that vitamin D not only makes for strong bones, but may play a role in preventing some chronic diseases later in life, including those involving the immune and cardiovascular systems,” explains Frank R. Greer, M.D., FAAP, professor of pediatrics at University of Wisconsin School of Medicine and Public Health.

Based on these findings the AAP has changed its previous recommendation of 200 IU per day to 400 IU a day beginning in the first days of life. “We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits,” says Dr. Greer, chair of the AAP Committee on Nutrition and co-author of the AAP’s clinical report on vitamin D. “Supplementation is important because most children will not get enough vitamin D through diet alone.”

Supplements for All
The AAP recommends vitamin D supplements for infants, children, and adolescents, including those who are breastfed. “Breastfeeding is the best source of nutrition for infants,” explains Dr. Wagner, a member of the AAP Section on Breastfeeding Executive Committee and co-author of the AAP’s clinical report on vitamin D. “However, it is important that breast-fed infants receive supplements of vitamin D. Until it is determined how much vitamin D a nursing mother should take, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day.” Once the child is weaned, a vitamin D supplement is needed throughout childhood and adolescence as well, she adds.

For formula-fed babies, the requirements are the same. Unless the child is drinking 32 ounces of infant formula per day, a vitamin D supplement is required.

Giving Supplements
When it comes to giving your child a vitamin D supplement, there’s nothing new about the process. “Any chewable multivitamin supplement for kids that contains 400 IU of Vitamin D is acceptable,” says Dr. Greer. “There are several liquid vitamin preparations for infants that contain 400 IU vitamin D per dose as well. Chewable vitamins are generally regarded as safe for children over the age of three who are able to chew hard foods and candy.”

For breast- or bottle-fed babies, liquid supplements are the best option. “There are liquid preparations that give the recommended intake of 400 IU in 1/2 or 1 mL, which are considered to be safer by some,” says Dr. Wagner. “There are also liquid drop solutions available that provide one drop that equals 400 IU per day. The care provider can put the vitamin D drop on an index finger and then place the finger in the baby’s mouth,” she suggests. “Alternatively, the drop can be put on a pacifier or breast and then when the infant sucks the pacifier or breast, the infant receives the vitamin.”

As with all medications and supplements, vitamin D supplements should be kept out of a child’s reach. “The risk with drop solutions is that an infant or other children in the house could receive too much vitamin D,” Dr. Wagner says.

Finding D Naturally
In addition to vitamin supplements, enriched foods are another way to increase the vitamin D in your child’s diet. Look for foods fortified with vitamin D such as milk, cereal, orange juice, yogurt, and margarine.

Vitamin D is found naturally in only a few foods — they include oily fish, beef liver, cheese, egg yolks, and some mushrooms. Oily (or fatty) fish are one of the best sources of the vitamin. For example, 3.5 ounces of cooked salmon offers approximately 360 IU (about 90 percent of your child’s daily recommended value) of vitamin D per serving. Other examples of oily fish include tuna, mackerel, trout, herring, sardines, kipper, anchovies, carp, and orange roughy.

Quick Tips: The ABCs of Vitamin D
How to make sure your child is getting enough vitamin D:

Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.
All non-breastfed infants, as well as older children, who are consuming less than 32 ounces per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.
Adolescents who do not get 400 IU of vitamin D per day through foods should receive a supplement containing that amount.
Children with increased risk of vitamin D deficiency, such as those taking certain medications and with chronic diseases such as cystic fibrosis, may need higher doses of vitamin D. Consult your pediatrician.
Quick Tips: Adding it Up
Here’s a look at some food sources of Vitamin D:

Did anyone see ANYTHING mentioned about getting some sun? I didn’t and I asked my friend who endorsed this and she responded, “Skin cancer?” I asked her why she thinks 10-15 min a day of a sun would cause that and she had no answer. She asked me if I recommend sun for my patients, after I showed her the research proving that lack of sun is as dangerous as smoking, and I emphatically said yes. The AAP and NIH are so intimidated by the idiotic dermatologists that they list margarine and its hydrogenated oils OVER the sun (see above).

Conclusion: food is okay for D but getting some sun is better and it may do more than just help us make D.

2. High-fat dairy consumers less likely to develop diabetes

This came from Time magazine and it should open your eyes….again. I do want to preface that is I think the issue here is more about fat than dairy. Dairy can be a little pro-inflammatory, hence why the Paleo gurus don’t like it. But that is a story for another day. Here are some highlights from the article:

In a new study published in the journal Circulation, Dr. Dariush Mozaffarian and his colleagues analyzed the blood of 3,333 adults enrolled in the Nurses’ Health Study of Health Professionals Follow-up Study taken over about 15 years. They found that people who had higher levels of three different byproducts of full-fat dairy had, on average, a 46% lower risk of getting diabetes during the study period than those with lower levels. “I think these findings together with those from other studies do call for a change in the policy of recommending only low-fat dairy products,” says Mozaffarian. “There is no prospective human evidence that people who eat low-fat dairy do better than people who eat whole-fat dairy.”

Since full-fat dairy products contain more calories, many experts assumed avoiding it would lower diabetes risk. But studies have found that when people reduce how much fat they eat, they tend to replace it with sugar or carbohydrates, both of which can have worse effects on insulin and diabetes risk. In the current study, Mozaffarian adjusted for the role that weight plays, and found the connection between full-fat dairy intake and lower diabetes risk remained strong independent of weight gain.

In fact, in a separate study published in the American Journal of Nutrition, another group analyzed the effects of full fat and low fat dairy on obesity and found that among 18,438 women in the Women’s Health Study, those who consumed the most high-fat dairy products lowered their risk of being overweight of obese by 8%.

Together, the body of data is beginning to reveal both that full-fat dairy has a place in a healthy diet, and also how focusing on one nutrient in the diet may backfire. When dietary guidelines began urging people to lower the amount of fat they ate, the idea was to reduce the amount of cholesterol and unhealthy fats in the body. But by focusing just on cutting out fat, experts didn’t count on the fact that people would compensate for the missing fat and start loading up on carbohydrates, which the body converts into sugar—and then body fat.

“This is just one more piece of evidence showing that we really need to stop making recommendations about food based on theories about one nutrient in food,” says Mozaffarian. “It’s crucial at this time to understand that it’s about food as a whole, and not about single nutrients.”

While it’s not entirely clear how whole fat is helping to lower risk of diabetes, it’s possible that it’s working on several different levels to regulate insulin and glucose. At the simplest level, people eating more high fat dairy products will have enough calories so they won’t feel hungry enough to need additional calories from sugary foods. It’s also possible that the fats in dairy may be acting directly on cells, working on the liver and muscle to improve their ability to break down sugar from food. And then there’s the possibility that for certain high fat dairy foods, like cheese, which is fermented, microbes may be working to improve insulin response and lower diabetes risk too.

Fat doesn’t matter unless it is man made crap (fried, burned oil, or trans fats) or if you mix it with carbs.

3. Vegetable Oil Studies Under Scrutiny

In a study published in the BMJ, researchers re-analyzed data from older unpublished studies and found the link between vegetable oil and heart health may not hold.

They revealed that it’s possible that too much vegetable oil could actually increase the risk of heart disease — rather than decrease it. Christopher Ramsden, a medical investigator at the National Institutes of Health, and his colleagues delved into the data from the Minnesota Coronary Experiment, conducted from 1968 to 1973. They learned that only part of the trial’s results were published, and other data, suggesting the contrary idea that switching animal fats for vegetable fats didn’t protect the heart, was left out.

This is the problem with some studies. Sometimes they are done poorly. Sometimes the authors are just stupid or sinister. In this study it actually found that people who ate animal fats tended to live longer than those who switched to vegetable oils. So, why is this? As I stated above, burning an oil will change its properties. The raw stuff is the real stuff:

The unsaturated fats found in vegetable oils, when they’re heated, tend to oxidize. In this form, they’re more dangerous to body tissues and can trigger inflammation, a known risk factor for making blood-vessel plaques unstable enough to cause a heart attack.

So what’s the take home message? You need a principled diet. Keep your carbs low. Animal fat is not a bad thing nor is vegetable fat. Don’t cook your olive oil. Use coconut oil or butter for that. In Italy, as I witnessed on my anniversary years ago, they will grill veggies and then poor raw olive oil over it.

4. Fast food = Industrial Chemicals in Your Body

A new study found that people who reported eating fast food in the last 24 hours had elevated levels of some industrial chemicals in their bodies. Phthalates, that are used to make plastics more flexible and durable and which don’t occur in nature, is what they are talking about. These things are common in cosmetics, soap, food packaging, flooring, window blinds, and other consumer products and the latest research suggests that fast food is a significant source of the chemicals, which may leach into food from machinery used in processing or packaging, or from gloves worn by workers.

Once again, the more processed the food is the more chances you are taking by eating it.

3/15/16

Many Supplements are Fraudulent

This article had some good information that I wanted to share with you. I have been taking supplements (though not now) for decades. Some were good but some were useless or worse, dangerous. The problem is NO ONE is watching over the industry and there are a lot of bad people trying to capitalize on the illness of others. I am not the expert in every supplement but I know quite a bit. Try to run them by me but I am more and more a believer of getting our nutrients through whole foods then via supplements. Anyway, here are the tips they give in the article:

How do you know a product is fraudulent? The FDA suggests looking for these claims:

One product does it all. Be suspicious of products that claim to cure a wide range of diseases.

Personal testimonials. Success stories such as “It cured my diabetes,” or “My tumors are gone,” are easy to make up and are not a substitution for scientific evidence.

Quick fixes. Few diseases or conditions can be treated quickly, even with legitimate products. Beware of language such as “lose 30 pounds in 30 days,” or “eliminates skin cancer in days.”

“All natural.” Some plants found in nature can kill if you eat them. Plus, FDA has found products promoted as “all natural” that contain hidden and dangerously high doses of prescription drug ingredients.

Miracle cure. Alarms should go off when you see this claim or others like it such as “new discovery” or “scientific breakthrough.” A real cure for a serious disease would be all over the media and prescribed by doctors—not buried in print ads, TV infomercials, or on Internet sites.

FDA-Approved. Domestic or imported dietary supplements are not approved by FDA. Finally, if you’re tempted to buy an unproven product or one with questionable claims, check with your doctor or other health care professional first. You can also check FDA’s website to see if the agency has already taken action on it.

More than half our calories come from ‘ultra-processed’ foods

Diet names come and go and that will never change. The bottom line is that if we work with nature, versus against it, we will succeed in the long run. The Paleo Diet seems to be the most successful for patients but in reality it is just a diet that mimics what man ate prior to the agricultural revolution. This was before the processing of food. A new study in the British Medical Journal found that a diet of ultra-processed foods, a group that includes frozen pizzas, breakfast cereals and soda, make up 58% of all calories Americans consume in a typical day. It also delivered 90% of the added sugars that Americans ate and drank. This is not good. Government health experts advise Americans to get no more than 10% of their total calories in the form of added sugars. We’re not even close. Want some more?

More than 75% of the sugar and high-fructose corn syrup eaten by Americans was used by the food industry.

Breads, cakes, cookies, pies and salty snacks were the most popular ultra-processed foods, as measured by their contribution to the day’s total calories.

If Americans are ever going to get serious about added sugars, they’ll have to cut way back on ultra-processed foods.

About 60 million Americans consumed more than 70% of their calories in the form of “real food” showing that there is hope.

The answer is simple just not easy. If it comes in a package, wrapping or box then you really want to stay clear. The more processed the food the more “pre-digested” it is and the higher your sugar. This means weight gain, insulin resistance, high cholesterol and diabetes. Whole foods that you make is the answers. Keep them lower in carbohydrates which turns out they normally are. That’s the beauty of nature.

Get Exercising

The best exercise known to man is ANY ONE YOU WILL DO. This means it doesn’t really matter as long as your consistent. Now if you are training to run a marathon or want to put on big muscle then it does matter. That is called sports specificity and we taylor programs for that. For the rest of us, you just need to get moving. This article gives a few tips that may work for you:

Turn Your Commute Into Productive Time

The daily commute is often seen as wasted time. Instead of sitting on a bus or sitting in traffic, change the way you get to work. This is the ideal time for physical activity because it’s the one part of your day you absolutely can’t avoid no matter how hard you try.

Consider riding your bike to work, or getting off the bus a few stops early and walking the rest of the way. Bringing exercise into the daily commute is as easy as leaving the house and enjoying a leisurely stroll.

Spend Your Lunch Hour in the Park

The park bench is the hidden fitness tool that you have never considered before. You can do everything from bench push-ups to jumping squats using it. Anything that gets your heart rate up counts as a type of fitness and will help with muscle toning.

Even if you decide against turning your lunch hour into an impromptu aerobics class, the walk to the park bench a few blocks away still counts as exercise.

You can even perform exercises in your office chair. As long as you have something sturdy to hold on too, not even bad weather is an excuse for not taking on proper exercise.

What about Fitness and Meetings?

Most meetings tend to be held in a conference room or over lunch. Talking business doesn’t have to be done in such a formal capacity, though. Consider taking in some sort of fitness activity. You can still talk business and instill good habits at the same time.

So what are some ideas for adding a physical edge to your meetings? First of all, you could do something as simple as go to a golf meeting. You could even go cycling and speak at a slow pace. As long as it gets your heart rate up, you’re doing the job.

Walking meetings are another great way of getting some light exercise, if getting sweaty isn’t on your agenda. Walking meetings can provide a change of scenery and help to reduce stress levels.

Workout at Your Desk

If making it to the gym is too much for you, it may be worth considering a workout at your desk. Rather than indulging in a coffee run, spend 15 or 20 minutes taking a fitness break. You can do this anywhere where you have something sturdy. Here are five easy exercises you can do.

Scapular Retraction — Roll your shoulders down and back, while squeezing them together. This will help to strengthen your upper back.

Stationary Lunge — Lunges will stretch the hip flexors and prevent them from tightening due to long sessions on the computer.

Plank — Place your hands flat on the floor and make sure your body is in a straight line, as if you were about to perform a push-up. Draw your belly back, as if you are trying to push it through your spine. Hold this pose for about a minute and repeat.

Push-Ups — Plant your hands on the desk and lower your chest to the desk. Push back and engage your shoulders to provide strength to those areas of the body. If you have enough space, you can even perform conventional push-ups.

Chair Dips — Place the palms of your hands on the edge of the chair behind you. Lift yourself off the chair and lower yourself as far to the floor as possible. Push yourself back up again. In the beginning, you may only be able to lower yourself a little bit.

Treat Fitness Like an Appointment

Treating fitness like an appointment gives it a sense of importance. Set a reminder on your smartphone and commit to it. If you have someone or something reminding you to do something every day, you are more likely to do it.

Remember, exercise is important for strength and for lung and heart capacity. It is not the greatest for weight loss. Diet is for that. You cannot “out exercise” a bad diet. Sorry.

2/15/16

Antibiotics Are Rarely Needed

The American College of Physicians and the U.S. Centers for Disease Control and Prevention issued guidelines stating that antibiotics are not needed for adults who have the common cold, bronchitis, sore throat or sinus infections. It is estimated that 50 percent of antibiotic prescriptions may be unnecessary or inappropriate in the outpatient setting. A lot of these organizations are worried about the spread of antibiotic-resistant infections as well as the needless cost to our healthcare system. They are right but the bigger issue we are going to find is how much these antibiotics destroy the good bacteria in our gut, which can lead to diabetes, obesity and more. So, what should people do when they have an upper respiratory infection? Well, for uncomplicated bronchitis use cough suppressants, expectorants, antihistamines, decongestants and beta-agonists (inhalers). For a sore throat, use aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and throat lozenges. For uncomplicated sinus infection. use some Sudafed or other OTC meds. Of course, you can always call me and we can check you out.

Easier to Be Skinny in the 1980s

There is a fascinating read in The Atlantic that talks about a study published in the journal Obesity Research & Clinical Practice that found that it’s harder for adults today to maintain the same weight as those 20 to 30 years ago did, even at the same levels of food intake and exercise. In fact, people today are about 10 percent heavier than people were in the 1980s, even if they follow the exact same diet and exercise plans. But why? We don’t know but here are three possibilities mentioned:

People are exposed to more chemicals that might be weight-gain inducing. Pesticides, flame retardants, and the substances in food packaging might all be altering our hormonal processes and tweaking the way our bodies put on and maintain weight.

The use of prescription drugs has risen dramatically since the ‘70s and ‘80s. Prozac, the first blockbuster SSRI, came out in 1988. Antidepressants are now one of the most commonly prescribed drugs in the U.S., and many of them have been linked to weight gain.

The micro biomes (gut bacteria) of Americans might have somehow changed between the 1980s and now and some types of gut bacteria make a person more prone to weight gain and obesity.

This is all just theories. I DO NOT buy the SSRI theory at all. From what I can tell, there may be more to this story. The whole higher carb eating is not even mentioned here and that has been turned on its head now. Lack of sun, due to the scare tactics of the dermatologists, may be adding to this problem. Also, technology that has made us lazier as well as their non native EMF could be doing something as well.

What is there to do about this? Well, don’t take unnecessary antibiotics. Use cleaner food and house supplies that have less toxicity. Get more sun. Eat lower carbs.

Fifty Year Old Men

The lowest point for American men, on average, is supposedly age 52. I saw this in a recent issue of Men’s Health but there is more information in this Newsweek piece. While people are living longer, white American men have experienced a decline in longevity in the age group of age 45 to 54. Being age 50 myself, this was news to me. What was the reason for this decline? Self-destruction by heroin. Why are men at this age self-destructing? It seems that is when mortality becomes more than just an abstract concept and unmet aspirations nag at us. While I couldn’t even recognize heroin if someone put it in front of me I do see the point of this article in the magazine and also see men at this age in my office going through the same problems. Heck, I have friends struggling with their mortality as well. I don’t have the answers to fix this exactly but it doesn’t mean it can’t be worked on. If you have an issue, talk to me. If your family member is a patient, have them talk to me. If your family member isn’t a patient then have them see their own doctor.

Seafood Is Critical

Many of you know how often I talk to you about seafood being a critical part of your diet. In fact, a vegetarian diet with seafood is really a version of the Paleo Diet. The DHA (Omega 3 Fatty Acid) in seafood cannot be matched by other foods and it is so important for our brains and tissues. We really cannot be optimal without it. Now here is some more information that has come out. Seafood consumption appears to be tied to reduced Alzheimer’s pathology in carriers of the APOE4 allele, according to a study in Journal of the American Medical Association. Interestingly, even though seniors who consumed the most seafood had elevated levels of mercury in their brain, they appeared not to have suffered any adverse effects from it. The study’s conclusions provides reassurance that while seafood is associated with higher brain levels of mercury, those amounts don’t seem to be linked to a higher risk of developing features of Alzheimer’s. This is really interesting stuff. I have heard that mercury is bad but there may be some cofactors in the same seafood that protect us from it. In other words, the benefit of eating the seafood much outweighs the risk.

1/15/16

On this page are the updates I do monthly. They are there for your perusal and have my comments and opinions. I often refer to them our office visits.

New Dietary Guidelines

The new federal dietary guidelines are out and there are some interesting recommendations as summarized in the NY TIMES:

Americans need to drastically cut back on sugar.

Teenage boys and men are eating too much meat, chicken and eggs.

There is not a warning to cut back on meat in general.

Limits on dietary cholesterol are gone.

The advice to cut back on sugar echoes similar advice from the World Health Organization and other groups, which have cited evidence that lowering added sugar could reduce the risk of obesity, heart disease, Type 2 diabetes and some types of cancer.

The guidelines for the first time advise Americans to focus less on individual nutrients and to think more broadly about overall patterns of healthy eating, like consuming a vegetarian or Mediterranean-style diet.

The guidelines also continue to tell people to sharply limit their intake of nutrients such as salt, sugar and saturated fat. Some of those restrictions – like the limits on sodium and saturated fat – have been challenged by new research and questioned by nutrition experts who say they’re outdated.

So what is the take home on this? You have to remember this is a political group that has broad implications that affects school lunches, food stamps, etc. They are very leery of plunging in too deep in what they feel is uncharted waters. Let me give my opinion on each one:

The sugar issues is major. Half of American adults are diabetic or pre diabetic. Low carb diets are key.

The meat, chicken, eggs thing is not an issue if their carbs are low. I would rather see more healthy fat on the diet and seafood as the critical staple.

I am not anti-meat but it really should be free range chicken, free range eggs and grass fed meat if possible. It also should not be the highest percentage of your diet

Cholesterol in diet means nothing. Never has.

The WHO was way ahead of us on this.

I love this. If you went to my Paleo Diet talk you would know that names of diets are meaningless to me. A vegetarian diet with fish (pescotarian) or the Mediterranean diet done right is really the Paleo Diet. Low carb. Higher healthy fats.

Salt is irrelevant. Saturated fat has advantages. Sugar is bad.

The NY TIMES did another piece on this later and the focus of that was no diet is right for everyone. Agreed. And people are trying to figure a way to find out:

This dawning realization has scientists, and entrepreneurs, scrambling to provide more effective nutritional advice based on such distinguishing factors as genetic makeup, gut bacteria, body type and chemical exposures.

How do you find what works for you? See your doctor? Well, no, not any doctor. Most doctors still think fat is bad and recommend a low fat unproven diet to help your health. You need a doctor who is versed in this stuff. Luckily, you have one. I am not the greatest but I know when to say I don’t know.

Understand that the future of medicine may be in the personalized recommendations route. People are charging a lot for this and not all of the testing, algorithms or material is accurate. Buyer beware. They will tell you, that with genetic testing, they can advise on how to eat. Remember, though, that your genes, your microbiome, your diet, your environment and your lifestyle are infinitely complex and keep changing.

Vitamin D

Tim Spector is a professor of Genetic Epidemiology, King’s College London and the Director of the British Gut microbiome project. He is author of The Diet Myth, a book on gut microbes. He talks about Vitamin D in this article and he is not selling anything, except maybe his book. just by giving his opinion. Many of you know that I am skeptical of Vitamin D supplementation. I am all for optimizing your D but taking it by a pill has not been shown to work. Here is a summary of Spectors’ article:

Surprisingly, there is a lack of evidence to support the health benefit claims of virtually all vitamin supplements on the market.

And last year massive analyses combining 27 studies on half a million people concluded that taking vitamin and mineral supplements regularly failed to prevent cancer or heart disease. Not only are they a waste of money for the majority of us – but if taken in excessive quantities they can actually hasten an early death, increasing your risk of heart disease and cancer.

Virtually no vitamins or supplements have actually been shown to have any benefit in proper randomised trials in normal people without severe deficiencies.

Since the 1980s, researchers (including myself) have written thousands of papers, associating a lack of our favourite vitamin with over 137 diseases. A 2014 BMJ report, however, found these links mainly to be spurious.

The evidence so far suggests (with the possible exception of multiple sclerosis and some cancers) that low vitamin D levels are either irrelevant or merely a marker of the disease.

One 2015 randomised study of 409 elderly people in Finland suggested that vitamin D failed to offer any benefits compared to placebo or exercise – and that fracture rates were, in fact, slightly higher.

The usual prescribed dose in most countries is 800 to 1,000 units per day (so 24,000-30,000 units per month). However, two randomised trials found that at around 40,000 to 60,000 units per month Vitamin D effectively became a dangerous substance.

Some people who don’t take supplements have naturally high blood levels which may be due to them spending large amounts of time outdoors in the sun or eating oily fish regularly – and there is no evidence that this is harmful.

Higher than average levels can also be due to genes which on average influence about 50% of the differences between people. So our obsession with trying to bring everyone up to a standard normal target blood level is seriously flawed, in a similar way to our one-size-fits-all approach to diet.

Vitamin D mainly comes from UV sunlight converted slowly in our skin to increase blood levels or is slowly metabolised from our food. In contrast, taking a large amount of the chemical by mouth or as an injection could cause a very different and unpredictable metabolic reaction. For example, our gut microbes are responsible for producing around a quarter of our vitamins and a third of our blood metabolites and also respond to changes in vitamin levels picked up by receptors in our gut lining. Any artificial addition of large amounts of chemicals will upset some sensitive immune processes.

So what is my take on this? I believe we need to get our vitamin D levels up. Do supplements accomplish this? Yes. Is it the same as sun and diet? No. We know a lot of medical problems/disease that are associated with a low D but giving those people D by supplement doesn’t help. Why? It could be that your lifestyle, diet, and environment is so bad that it lowers your D but fixing the messenger (the low D) does not fix the lifestyle, diet or environment.

This discussion will probably turn into a new lecture.

Eating Late

You do not want to eat late at night. If you had seen the Paleo Diet video I have recommended in the past you would have heard about insulin being a bad actor, especially at night. It block Leptin, the hormone that tells you to burn fat as heat while asleep, and so you have trouble losing weight. I just found this other article on an MSN site and it added to the reasons of why you shouldn’t be eating late.

Snacking on popcorn, ice cream, or reheated leftovers late at night may cause memory problems when you wake up.

Taking regular meals at the wrong time of day has far-reaching effects for learning and memory.

A certain group of genes are in charge of regulating the circadian clock, learning, and memory, which are regulated by a protein called “CREB” (cAMP response element-binding protein). Mice that ate at night also had a significantly less active CREB protein than when they ate during regular eating hours. Because CREB may also play a role in the onset of Alzheimer’s, researchers now wonder if unhealthy eating patterns could put a person at greater risk of developing the neurodegenerative disease.

We have shown that simply adjusting the time when food is made available alters the molecular clock in the hippocampus and can alter the cognitive performance of mice.

I have written before about intermittent fasting and how I believe that the magic 8 hour window should end early in the day and this is more evidence why. I also believe you will lose more weight if you stop eating earlier.

5 Symptoms of Laziness

12/15/15

The Cold Affects Your Gut Bacteria

You may not know this but “exposure to cold temperatures is known to mimic the effects of exercise, protecting against obesity and improving metabolic health”. There are many reasons why this happens but a recent study showed the beneficial health effects of cold exposure may be caused by your gut microbes as well. The researchers found that cold exposure dramatically alters the composition of intestinal bacteria in mice and that this microbial shift is sufficient to burn fat, improve glucose metabolism, and reduce body weight. Some more from the article:

In support of this idea, they found that exposure to a cold temperature (6° Celsius, 43° Fahrenheit) for up to 10 days caused a major shift in the composition of gut microbes while preventing weight gain in mice.

Transplanted cold-induced gut bacteria into other mice improved glucose metabolism, increased tolerance to cold temperatures, and caused weight loss in the recipient mice by promoting the formation of beige fat.

The point I find interesting is not so much in the discovery of a new “bacteria” pill. I am more intrigued about using the cold to your benefit. Circadian biology is important and we need to feel cold in the winter. That allows the right bacteria to exist and also allows us to burn more fat.

Vitamin S

Fresh raw sardines with parsley and lemon on wooden background

If you have seen me in the office you know how much I believe in eating sardines. Why? DHA, the best Omega 3 fatty acid for health and remember, a supplement is never the same as the food. Here is an article that talks a little about it but also gives you 51 recipes. Here are some more reasons mentioned in the piece.

Sardines are packed full of omega 3 fatty acids EPA and DHA. More than salmon and most other seafood!

Sardines are a great source of vitamin D. A vitamin many of us are deficient in.

Sardines are one of the top sources for B12 content (behind beef liver). A vitamin vital for our metabolism and heart health. So if you’re not eating liver on a regular basis, don’t worry, have a can of sardines instead!

Sardines are high in minerals such as phosphorus, calcium, potassium and selenium.

Sardines are low on the food chain, meaning they have less accumulated heavy metals such as mercury that bigger fish like tuna have.

Finally they’re a great low carb, high protein and fat food source.

Quick Tips

When you get up, eat a high protein meal within 30 minutes of arising. A recent study in the International Journal of Obesity on overweight teenagers showed they had lower glucose levels and reduced body fat

Researchers form the University of Michigan examined more than 500 foods and concluded that CHEESE is one of the most addictive foods due to the casein in it. The casein gives you a high by tripping your dopamine receptors.

Silence -Waking up early offers you opportunities that few get to enjoy – watch the sun rise, hear the sound of birds chirping, and just be still. We are always on the move. Sit and enjoy the morning calm. It’s a brief time where you can be alone with your thoughts. Just breathe.

Go to bed early – If you want to watch one more episode on Netflix think again. Getting the proper amount of sleep is critical to not only your mental health and creativity but to weight control. When your biorhythms are off it wreaks havoc on your entire system. Getting the proper sleep your body needs sets you up for success in everything else you want to achieve. So rest up, you have much to accomplish tomorrow!

Toss it! – Learn to let go of the things that are cluttering your life. It’s one thing to try to clear your mind, but sometimes you have to physically toss something to feel lighter. So get rid of something – old magazines, junk mail, apps on your phone, old receipts or papers and watch how your attitude changes throughout the day. Our lives get cluttered so easily, but they can become uncluttered just as fast. Remember that.

Pack snacks – Eating fuels your brain, improving focus, productivity and memory. Plan your snacks ahead of time and drop some bars into your bag. I opt for a protein-filled KIND Bar which is completely natural and prevents my blood sugar from dropping. Smart snacking is critical for keeping your metabolism going and your brain working at full capacity through your busy day.

Get moving – Morning workouts not only give you a boost of energy, they pump you up, ensuring your senses are up and running. You’ll feel ready to tackle any problem that comes your way. Studies have shown that people are less likely to come up with excuses early in the morning. So with fewer interruptions, you now have no excuse not to set your alarm 15 minutes early and sneak in a quick jog or a 5 minute workout. There’s even an app,Hot5 Fitness, that features easy and effective full body workouts.

Motivational Mantra – Step One – Dig deep and find out what inspires you. Step Two – Create a mantra. Step Three – Repeat that same saying to yourself every morning. Step Four – Breathe and relax. You will feel more motivated and focused than ever before.

Say Buh-Bye To THAT One Big Task – Reprioritize your to-do list, placing the most dreaded task at the top of your list. Instead of letting it loom over you all day save yourself the agony and stress and get it done first thing. You will feel a sense of relief and be more ready and willing to tackle any trivial task that follows. Besides, the morning is the time when you typically have the most energy and feel the most rested. Sounds like a win-win to me!

Eat Breakfast – Time is a luxury, enjoy it and feed yourself a wholesome breakfast. Sit down with your family and enjoy a hearty bowl of oatmeal. Fuel your body for the tasks that lay ahead of you. It will help you maintain a steady focus throughout the day.

Visualize – Early hours foster reflection. Enjoy the quiet and take some time to map out your day. Think through your goals and to-dos. Take whatever notes you need to ensure your day will be calmer and more efficient. Research has shown that even two minutes of visualization and positive thinking can improve your mood and clarity for the entire day ahead.

Get Up and Hour Early – There is a 25th hour in the day. You’ve just been sleeping through it. Getting up an hour earlier is going to take time to adjust to, but once you make it a habit, you will never look back. Research has shown, not only are early risers more optimistic and conscientious, they also anticipate problems and minimize them more efficiently. Which of course is crucial to success in the business world.

11/15/15

Medical Care in Small Amounts and with Big Price Tags

This article in the Washington Post shows how quality of care is horrible when people are rushed through. It is called “When medical care is delivered in 15-minute doses, there’s not much time for caring” and that about says it all. Maybe the bigger concern is when hospitals own doctors. Not only are they pushed to these 15 minute visits but they raise the rates. Here is an article in the Boston Globe that is called “Visits to the doctor cost more as hospitals buy practices” that sums it up pretty well. The bottom line is that doctors’ visits are getting shorter and costing more. I am proud to NOT be a part of this trend.

The Sun is Not Evil

The article is called Is Profit Behind Dermatology’s ‘Sun Scare’ Message? and it is worth the read. I never thought the sun was so evil. Information is coming out that sunglasses and sunscreen could even make things worse. Weird, right? We need the D. We need our solar panels to convert that sun to D. Low D gives a higher risk for depression, diabetes, dementia and on and on. So why do the dermatologists hate it so much? Here are some points from the piece:

What’s really behind the ‘sunshine is killing us’ message that’s pouring out of dermatologists’ mouths, via the media, these days?

A May 2010 study in the Journal of the National Cancer Institute listed melanoma as one of five cancers over-diagnosed by doctors.

A 2009 British Journal of Dermatology report also concluded: that melanoma isn’t increasing in actual incidence, but merely in reported incidence. What the report found was doctors were simply reporting and removing more lesions that may not actually be cancerous.

Riddle me this: how is it possible the U.S. estimates more-than-triple while Canada’s real numbers are actually declining? Has the U.S. dermatology-induced media scare propagated more dermatologist visits in our for-profit health care system or are a larger number of Canadians simply staying inside to watch their beloved championship curling teams?

This past spring the Association of Health Care Journalists called into question dermatology’s math about melanoma. AHCJ reported a person’s risk of melanoma is identified at roughly two-to-three per thousand. (Whether they catch sun outdoors or in a tanning bed.) Melanoma is quite rare and it’s actually declining in most of the population, except for older men, who get it most often. Oddly, the media marketing campaign for skin cancer prevention is aimed almost entirely at young women, who have less than a one in 100,000 chance of succumbing to melanoma. According to the National Cancer Institute’s data, that number has actually gone down more than 50 percent in women 20 to 49 since 1975.

And yet, dermatology leaders regularly state that melanoma is the fastest growing cancer in women between the ages of 25 to 29 — ignoring men, the group most at risk, altogether. Is there a correlation between young women being the largest consumers of skin care products as well as being the largest demographic group scared into dermatologists’ offices to have moles removed? (

I then ask what measures I should take to prevent skin cancer. I’m told to apply sunscreen 24/7, wear a hat and sunglasses, as well as avoid the sun as much as possible. (The only thing she doesn’t mention is to live underground with the mole people.) I ask her if she wears sunblock. She does, SPF 30 and higher. She reminds me to reapply. I told her I read that some sunblocks are bad for you. “We don’t believe that,” she said. “The sun is more harmful.”

Some sources suggest that the rise in skin cancer cases is due to the excessive use of sunscreens due to the toxic ingredients that we’ve recently learned seep into our bodies, rather than the increased exposure to ultraviolet light. Nearly half of the 500 most popular sunscreen products may increase the speed at which malignant cells develop and spread skin cancer because they contain vitamin A or its derivative. According to researchers at Environmental Working Group, their annual report cites problems with bogus sun protection factor (SPF) numbers, the use of the hormone-disrupting chemical oxybenzone (which penetrates the skin and enters the bloodstream), overstated claims about performance, and the lack of needed regulations and oversight by the Food and Drug Administration. If their claims are correct, then even though the white sunscreen goop might prevent sunburn don’t count on it to prevent skin cancer from forming.

More goop for thought: sunscreen companies can’t actually advertise that their product prevents skin cancer because research doesn’t support that claim. So companies fork over millions of dollars in “pay for play” endorsements to groups like The American Academy of Dermatology and The Skin Cancer Foundation to make that claim for them. Indeed, most people are surprised to learn that the Skin Cancer Foundation is mainly funded by the very pharmaceutical companies who profit from its anti-sun message.

She neglects to mention that constant use of sunscreen is suspected to be a factor in vitamin D deficiency–a condition that affects three-quarters of U.S. teens and adults. According to findings in the Archives of Internal Medicine, the deficits are increasingly blamed for everything from cancer and heart disease to diabetes.

I ask if sunblock prevents cancer. I’m told it prevents skin damage, which can cause cancer. Linking these two elements together makes it imply that sunscreen is the antidote for skin cancer, rather than a preventative against skin damage.

This being said, I want people to know that excessive sun on unhealthy skin is bad. This is a long story that I may do a talk on but the truth is that I found a melanoma on myself and got it out just in time. I was using a tanning bed in the winter of Maine.

Colorectal Cancer Screening Guidelines

Regular screening, beginning at age 50, is the key to preventing colorectal cancer. The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer using high-sensitivity fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 50 years and continuing until age 75 years. The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, check with Dr. Farrago to see if you should be screened.

Flexible sigmoidoscopy – physicians use a flexible, lighted tube (sidmoidoscope) to look at the interior walls of the rectum and part of the colon and should be done every five (5) years with FOBT every three (3) years. (NOT MY CHOICE)

Colonoscopy – physicians use a flexible, lighted tube (colonoscope) to look at the interior walls of the rectum and the entire colon and should be done every 10 years.

Can be used as screening test or as a follow-up diagnostic tool when a patient has symptoms and it can be used as a follow-up test when the results of another colorectal cancer screening test are positive, unclear, or abnormal.

These basic guidelines are recommended for asymptomatic patients. Individuals with any colorectal cancer risk factors should undergo colonoscopies at an earlier age and more frequently than average risk individuals. Talk with me to see what guideline is best suited for you or if you have concerns about your risk factors.

Bed Mode for Smart Phones

For those of you who missed my lecture on The Dangers of Today’s Technology, you have a lot of catching up to do. A recent article from the BBC website did a nice piece on getting the phones away from your bed. Professor Paul Gingras argues that the the setting should filter out the blue light that delays the body clock and keeps people awake later into the evening but every new model was “bluer and brighter”. Why is this recommended? Because “as it gets darker in the evening, the body starts to produce the sleep hormone melatonin – which helps people nod off.” Prof Gringras added: “It’s not good enough to say do less and accept this is the world we live in, they’re fun devices but we do need some protection on what they do at night-time.”

This doesn’t even mention the issue of the EMF. Anyway, I recommend to turn you phone off if you can or keep it out of your bedroom.

10/15/15

CHECK YOUR MEDS

If you are being prescribed medications by me then please check that they work well with each other. Yes, I try to check too but you always should be the master of your own healthcare . You can check interactions by going to:
http://reference.medscape.com/drug-interactionchecker

This will tell you whether there is a problem between your meds and then you can contact me to see if it truly is worrisome.

WE EAT FOR TOO LONG!

A recent study looked at consumption patterns of just over 150 nondieting, non-shift-working people in and around San Diego for three weeks. Most people eat for stretches of 15 hours or longer most days and fast for fewer than nine hours a night. The bottom line is that we are major grazers that never stop eating. And we eat too late! The study showed that fewer than a quarter of the day’s calories were consumed before noon. Even worse, more than a third of participants’ average daily calories were consumed after 6 p.m. I was blown away by this until I realized that this was me! Even though I try to do Paleo 99% of the time, when I looked at my weak points it was when I came from work. I was the people in this study.

The study also found 12% of participants’ daily average intake of 1,947 calories happened after 9 p.m. and those final 12% were extra and above those needed to keep weight stable.

This LA Times article mentions a study I referenced before:

In mice being fed high-fat chow, the Salk researchers’ past studies have shown that among those allowed to eat anytime, obesity was rampant. When researchers compressed the animals’ “feeding day” to eight or nine hours, those with the long fast stepped up their calorie consumption when they were allowed to eat.

Both groups of mice ended up taking in equal calories. But the fasting mice were less likely to be obese, and had lower levels of systemic inflammation, fatty liver disease, worrisome cholesterol and metabolic disturbance than those allowed to eat whenever they wanted.

Same calories and less obese!!

Another group of researchers basically tried this with overweight or obese humans whose general “eating day” normally spanned more than 14 hours. They were to limit their consumption of anything with more than five calories to a 10- to 12-hour span each day, then to fast for the remaining 12 to 14 hours. Over 16 weeks, the study participants lost an average of just over 7 pounds.

This diet plan is called intermittent fasting. In my opinion, however, fasting for 12 to 14 hours is not enough. The better way to go, after researching this on my own, was to have an 8 hour window of eating and fast for 16 hours. So, two months ago I started this. I ate only between 7 am and 3 pm. Nothing at night. I did have a cheat day on Saturdays where anything or everything goes. At this time I have dropped 20 stubborn pounds. It is not easy but it is getting easier.

I will talk to anyone individually about how they can IF (intermittent fast) but I also plan to do a talk on it at some point.

CALCIUM

Calcium was always recommended as the go supplement for bone health. We were sure of it. I have been recommending it for osteoporosis ever since I have graduated medical school. Turns out that we were wrong again. Two new studies suggest a lack of evidence to support taking calcium for better bone health or to prevent fractures. They state that the “small reductions in total fractures seem outweighed by the moderate risk of minor side effects” which include constipation as well as more severe complications, like cardiovascular issues. They are suggesting that clinicians, advocacy organizations and health policymakers NOT recommend calcium supplementation for fracture prevention. You can read this Time article for more info but until then, I agree that no calcium is needed. Many of you know that I am not a huge believer in most supplements anyway. Why? Because you can’t “outsupplement” a bad diet. Diet should be optimized first. Is there anything for osteoporosis then? After diet, we are not sure. I am intrigued by vitamin K2 but more about that later.

PALEO DIET (HIGH FAT, LOW CARB)

I am leaving this video up here because it is the basis for the diet I recommend to everyone. This explains a diet that is NON-INFLAMMATORY for your system. There are others but I think this is the easiest to follow. This is a doctor doing a similar thing I am doing. He explains the Paleo Diet so well that I think it needs to be seen by everyone.

9/15/15

Screen Time

This article Psychology Today is really interesting. It seems everyday electronics may be the cause for children or teens to be “revved up” and prone to rages, depression and apathy. It can also cause chronic irritability, exhaustion and make them struggle academically and socially. The author talks about successfully treating a child with mood dysregulation today with methodically eliminating all electronics use for several weeks—an “electronics fast” to allow the nervous system to “reset.” If done right they can get “deeper sleep, a brighter and more even mood, better focus and organization, and an increase in physical activity. The ability to tolerate stress improves, so meltdowns diminish in both frequency and severity. The child begins to enjoy the things they used to, is more drawn to nature, and imaginary or creative play returns. In teens and young adults, an increase in self-directed behavior is observed—the exact opposite of apathy and hopelessness.”

This article entitled Steve Jobs Was a Low-Tech Parent in the New York Times is pretty eye-opening. The tech CEOs know something we don’t. Here are some highlights:

“So, your kids must love the iPad?” I asked Mr. Jobs, trying to change the subject. The company’s first tablet was just hitting the shelves. “They haven’t used it,” he told me. “We limit how much technology our kids use at home.”

Chris Anderson, the former editor of Wired and now chief executive of 3D Robotics, a drone maker, has instituted time limits and parental controls on every device in his home. “My kids accuse me and my wife of being fascists and overly concerned about tech, and they say that none of their friends have the same rules,” he said of his five children, 6 to 17. “That’s because we have seen the dangers of technology firsthand. I’ve seen it in myself, I don’t want to see that happen to my kids.”

Alex Constantinople, the chief executive of the OutCast Agency, a tech-focused communications and marketing firm, said her youngest son, who is 5, is never allowed to use gadgets during the week, and her older children, 10 to 13, are allowed only 30 minutes a day on school nights.

Evan Williams, a founder of Blogger, Twitter and Medium, and his wife, Sara Williams, said that in lieu of iPads, their two young boys have hundreds of books (yes, physical ones) that they can pick up and read anytime.

War on Saturated Fat is Over

I really try to use this space to reinforce some common themes. Diet, exercise, electronics, water, etc are all part of what I will hammer on over and over. So, here we go again. Researching covers from Time magazine, Examiner visually showed how diet recommendations have really changed. You can watch the report above but also read this article. Some other tidbits from the piece:

‘Anti-Fat Crusade Was Driven By Corporate Greed’

Low-Carb Diets Curb Pro-Inflammatory Insulin Spikes

Eat Fat and Get Thin

8/15/15

Bad Doctors

The system is broken. Patients are being herded through their visits like cattle. I used to do this. I was guilty of the game but I have changed. We should not stand for this anymore. One of the most important metrics for good care is time spent with the patient. That means listening to her or him and also means caring. This article, from a website by a friend of mine (Val Jones MD), really sickens me. Please read it HERE. I want to take one section from the piece to show you:

I ask (in a slightly slurred tone) for more information, to which he responds in a loud voice, “You’re not going to remember any of this so just be quiet and listen!”

I persist in my attempts to understand the details, to which he shouts “Shut up and listen” with increasing decibels. When I say that the findings still don’t explain my symptoms and that I remain perplexed, he says I should “try probiotics.”

I hope I never act like this doctor but if I do then I hope you call me on it. I also hope that if any doctor in town acts like that towards you that you tell me. I want to stop referring patients to those doctors. We can all help fix this!

Science has proven that burning more calories than you consume will result in weight loss. But the trouble is that this only has short-term results. For long-term weight loss, it simply doesn’t work, say renowned obesity experts in a recent JAMA commentary.

Ultimately their argument is this: stop counting calories.

They say we should stop viewing weight as something separate from other biological functions—like hormones and hunger and the effects of what foods we eat, not just how much of them.

What, then, is causing the obesity epidemic? The authors say it’s refined carbohydrates. Sugar and processed grains like white bread which have become ubiquitous in our diets, and one of the reasons refined carbs is the prime culprit is that we’ve spent far too long chastising fat.

Refined carbohydrates spike insulin levels. Basically, when you eat a lot of refined carbs, like say, a 100-calorie pack of Oreos, it causes a surge of insulin that will trigger your fat cells to soak up calories—but there are not enough calories and nutrients to provide the energy that our bodies need. The brain recognizes this discrepancy and triggers a hunger response that also slows our metabolism. We are then going to want to eat more.

In summary, it goes back to carbs again. But that really is a very general overview. A better rule is that you need to EARN YOUR CARBS. I first heard this from a famous training guru Charles Poliquin. What he is saying is that until you get insulin sensitive (body fat lower than 10% and you can see your abdominal muscles) then it is a low carb diet for you. How much? Probably less than 100 grams a day. That is what the evidence is saying. There is more to it and everyone should have an individualized plan, which is what I do in the office. I spend an inordinate amount of time doing. Keep checking these updates as I add more info to the diet dilemma.

WiFi Dangerous to Kids

Here is a recent article in Forbes and it is scary. I have told many patients about the worrisome news I have been hearing about EMF (electromagnetic fields). They are everywhere. Your WiFi, your microwave, the power lines, your electric clock, your computer, your cellphone, your voltage boxes and on and on. They put out an electrical field and they put out a magnetic field and these things obviously go through everything so why wouldn’t they be going through us? The question is, what do they do when they go through us? Here is a summary from the article about WiFi and kids:

Most parents would be concerned if their children had significant exposure to lead, chloroform, gasoline fumes, or the pesticide DDT. The International Agency for Research on Cancer (IRIC), part of the United Nations’ World Health Organization (WHO), classifies these and more than 250 other agents as Class 2B Carcinogens – possibly carcinogenic to humans. Another entry on that same list is radiofrequency electromagnetic fields (RF/EMF). The main sources of RF/EMF are radios, televisions, microwave ovens, cell phones, and Wi-Fi devices.

…we may need to limit that exposure, when possible.

That was among the conclusions of a controversial survey article published in the Journal of Microscopy and Ultrastructure entitled “Why children absorb more microwave radiation than adults: From an analysis of others studies, the authors argue that children and adolescents are at considerable risk from devices that radiate microwaves (and that adults are at a lower, but still significant, risk).

The following points were offered for consideration:

Children absorb a greater amount of microwave radiation than adults.

Fetuses are even more vulnerable than children. Therefore pregnant women should avoid exposing their fetus to microwave radiation.

Adolescent girls and women should not place cellphones in their bras or in hijabs (headscarf).

Cellphone manual warnings make clear an overexposure problem exists.

Government warnings have been issued but most of the public are unaware of such warnings.

Current exposure limits are inadequate and should be revised.

“Will we look back (sadly) in fifty or a hundred years and marvel at how Wi-Fi and cellphones were responsible for the biggest health crisis in human history?”

My next talk will probably be on whether Technology is Killing Us and Our Family. I think the answer is yes if used too much and without thought. More to come.

7/11/15

A Podcast to Listen To

This is a podcast where Dr. Jack Kruse is interviewed. He is a neurosurgeon whose material (www.jackkruse.com) I have been following for 5 years. I also have read his Epi Paleo Prescription book and have communicated with him a few times via email. He is out there. I mean waaaaayyyy out there in his medical beliefs. The problem, however, is that I think he is onto something big. If you can, I would recommend you listen to him while being interviewed in this podcast. It is #75.

Kruse is brilliant. He was over 357 pounds and lost almost 150 of it. More importantly, he applies quantum biology to all our health issues. This stuff is intense and NOT taught in medical school. He may have the answers to a lot of our medical mysteries. For example, he explains how we are basically batteries and need water, DHA, magnetism, sunlight, grounding, etc. This may blow you away. I would love your thoughts on this.

How Much Water Should You Drink?

I get asked this question a lot. The answer I have told people, from years of hearing different advice, is about 100 ounces a day. This article just came out and gave some thoughts:

A panel of 17 experts from around the world collaboratively wrote guidelines outlining the safest way to drink water without going overboard. The new guidelines were accompanied by warnings, published in the Clinical Journal of Sport Medicine, and announced at the International Exercise-Associated Hyponatremia Consensus Development Conference. According to the experts, 14 deaths of marathon runners, football players, and other athletes have already been attributed to drinking too much water or sports drinks during a physical activity. The condition is known as exercise-associated hyponatremia (EAH), in which the kidneys become overwhelmed by the large quantity of liquid it’s forced to process. The body’s naturally occuring sodium can’t keep up with the amount of water, leading to swelling in the cells and in severe cases, death. The panel recommends preventing hyponatremia by being in tune with your body and drinking when you’re thirsty — no more, no less. In order to replenish the body with enough water without overwhelming the cells, the Institute of Medicine determined the ideal amount is approximately 16 8-ounce cups (3.7 liters) for men and 11 8-ounce cups (2.7 liters) for women. For athletes or anyone about to engage in a physical activity that will make you sweat, drink 1.5 to 2.5 extra cups of water to compensate for the fluid loss. Because sodium is lost through sweat perspiration, drinking a sports drink that contains sodium will help replace and balance out the increased water intake while reducing the chances of developing hyponatremia.

So, to round it out, I would say…about 100 ounces of water a day or a little more if you are sweating hard. And you may want to a little salt to it.

Oh, if you watch the video at the end of the article you will see another tidbit about water. Good advice and coincidentally, Dr. Robin Miller, who is in the video, is my friend. Small world.

Gut Bacteria and Mood

In this article the discussion once again come up about gut bacteria or the gut microbiota. The genetic material of these trillions of microbes, as well as others living elsewhere in and on the body, is collectively known as the microbiome. Taken together, these bacteria can weigh as much as six pounds, and they make up a sort of organ whose functions have only begun to reveal themselves to science. Here some highlights from the piece:

These bacteria make neurochemicals and this communication may have an influence on our behavior.

Bacteria in the gut produce vitamins and break down our food; their presence or absence has been linked to obesity, inflammatory bowel disease and the toxic side effects of prescription drugs.

Biologists now believe that much of what makes us human depends on microbial activity.

Micro-organisms in our gut secrete a profound number of chemicals, and researchers like Lyte have found that among those chemicals are the same substances used by our neurons to communicate and regulate mood, like dopamine, serotonin and gamma-aminobutyric acid (GABA). These, in turn, appear to play a function in intestinal disorders, which coincide with high levels of major depression and anxiety.

Anxiety, depression and several pediatric disorders, including autism and hyperactivity, have been linked with gastrointestinal abnormalities.

It has long been known that much of our supply of neurochemicals — an estimated 50 percent of the dopamine, for example, and a vast majority of the serotonin — originate in the intestine, where these chemical signals regulate appetite, feelings of fullness and digestion. But only in recent years has mainstream psychiatric research given serious consideration to the role microbes might play in creating those chemicals.

There is a lot of money going into understanding these buggers. All I can say is that we need to do whatever we can to make them healthy and limit the harmful ones. Backing off carbs helps.

6/9/15

THE CHOCOLATE STUDY SCAM

I had mentioned at the Paleo Talk how studies can and are manipulated. This article called, I Fooled Millions Into Thinking Chocolate Helps Weight Loss. Here’s How, proves it by creating a bogus study showing that eating chocolate can make you thinner faster. The only “fibs” the guy made up was to tweak his name a bit and create a fake website called The Institute of Diet and Health. The rest of the study was “legitimately” performed but done in a way to get the results they wanted.

“It was, in fact, a fairly typical study for the field of diet research. Which is to say: It was terrible science. The results are meaningless, and the health claims that the media blasted out to millions of people around the world are utterly unfounded.”

In other words, the goal was to “reveal the corruption of the diet research-media complex by taking part.” The authors randomly assigned the subjects to one of three diet groups. One group followed a low-carbohydrate diet. Another followed the same low-carb diet plus a daily 1.5 oz. bar of dark chocolate. And the rest, a control group, were instructed to make no changes to their current diet. They weighed themselves each morning for 21 days, and the study finished with a final round of questionnaires and blood tests. The results?

Both of the treatment groups lost about 5 pounds over the course of the study, while the control group’s average body weight fluctuated up and down around zero. But the people on the low-carb diet plus chocolate? They lost weight 10 percent faster. Not only was that difference statistically significant, but the chocolate group had better cholesterol readings and higher scores on the well-being survey.

You really need to read the rest of the article to enjoy how the story goes and how the data was “scientifically massaged” to make it successful. They did this to prove a point and that is to IGNORE the media when it come to new studies coming out, especially in nutrition. The picture above is from an actual media site.

RETHINKING BUTTER, BEEF, AND BACON

“It’s not a sin,” says Steven Nissen, MD, chair of Cardiovascular Medicine at Cleveland Clinic. Dr. Nissen and other top cardiologists want you to know that things are changing in our view of diet and heart disease. Yup, you read that right. I have been saying that the Paleo Template is going to be the one that science gravitates to. They will just call it the Mediterranean Diet or Vegetarian Diet with Fish. This article from the Cleveland Clinic is pretty good. Here are some highlights:

You may not have to give up high cholesterol foods like butter, beef and bacon. “High cholesterol is a metabolic condition that can only be moderately influenced by diet,” says Dr. Nissen. “Most circulating cholesterol is produced by the liver. Dietary cholesterol accounts for only about 15 to 20 percent of blood cholesterol. Changing the diet typically has only a modest effect on serum cholesterol levels.” According to the above-cited Scientific Report, “Available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol.” (THOSE WHO WENT TO MY CHOLESTEROL TALK WOULD HAVE HEARD THIS)

Dr. Nissen is strongly opposed to highly publicized low-fat diets that supposedly reverse coronary artery disease. “You can use a bit of butter to flavor your food,” he says. “Moderation is key. There are a lot of reasons to hedge your bets, but you don’t have to absolutely avoid saturated fats. You just want to keep them under control.

High blood pressure raises the risk of heart attack, stroke and other deadly conditions. If you have high blood pressure, you need to work with your doctor to get it lower. But you may not have to give up salt. For a long time, salt has dominated the popular view of high-blood pressure and its prevention. But a recent study of more than 8,000 adults found only a modest relationship between salt intake and systolic (the top number) blood pressure. This study found that most important modifiable risk factor for high blood pressure is body mass index – in other words: lose weight.

For generations, eggs and red meat have topped the list of foods implicated in cardiovascular disease because of their high levels of dietary cholesterol. But the new science-led exoneration of fat described above would seem to let red meat and eggs off the hook. And it largely has, as regards fat. But a whole new line of investigation focused on intestinal bacteria is keeping eggs and red meat in the spotlight.

Stanley Hazen, MD, PhD, Section Head of Preventive Cardiology and Rehabilitation at Cleveland Clinic, has published one study after another linking the metabolic product of bacterial digestion of substances found in red meat and egg yolks with development of pathologies ranging from atherosclerotic plaque to heart failure to chronic kidney disease.

I am going to let you read the rest on your own. The whole article puts together a lot of what I write here in these updates. The microbiome, the Paleo Diet, etc. Overdoing anything (red meat) is still an issue. Think veggies, veggies, veggies and then seafood as your first protein.

Lyme disease makes the headlines but there are plenty of additional reasons to avoid tick bites. New research highlights the latest in a growing list of tick-borne threats – a distant relative of Lyme that’s easy to confuse with other illnesses.

Monday’s study suggests a kind of bacteria with an unwieldy name – Borrelia miyamotoi – should be on the radar when people in Lyme-endemic areas get otherwise unexplained summertime fevers. It’s one of several recently discovered diseases linked to ticks in different parts of the country, a reminder to get tick-savvy no matter where you live.

“People need to be aware of what tick-borne diseases are in their area,” says Dr. Peter J. Krause of Yale University, a specialist who reviewed the research. “And they should know how to avoid ticks.”

WHAT’S THIS NEW INFECTION?

The first U.S. case was reported in 2013 in New Jersey, an 80-year-old cancer survivor who over four months became increasingly confused, had difficulty walking and lost 30 pounds. Doctors found spiral-shaped bacteria in her spinal fluid that looked like Lyme but caused a relapsing fever more closely related to some other tick-borne illnesses. While treatable by antibiotics – the woman recovered – doctors know little about B. miyamotoi.

Monday’s study offers some clues. Researchers with Imugen Inc., a Massachusetts testing lab, tested blood samples from patients in Massachusetts, Rhode Island, New Jersey and New York whose doctors suspected tick-borne illnesses and used that lab. During the 2013 and 2014 tick seasons the lab found 97 cases of the new infection. That’s roughly 1 percent of samples tested and close to the lab’s detection of a better-known tick disease named anaplasmosis, researchers reported in Annals of Internal Medicine. More research is needed to determine just how prevalent the disease is.

Researchers then analyzed medical records from 51 of those patients, and found symptoms typically include a high fever, severe headache, chills and blood abnormalities – decreases in infection-fighting and blood-clotting cells. About a quarter of patients were hospitalized, although Imugen medical director Dr. Philip Molloy cautioned that’s probably because doctors are seeking testing only for their sickest, most puzzling patients.

The bacterium is carried by deer ticks, also known as blacklegged ticks, which also can spread Lyme and two other illnesses, babesiosis and anaplasmosis.

IT’S NOT THE ONLY NEW WORRY

Two new tick-borne viruses were recently discovered in the Midwest, and neither has a specific treatment.

The Centers for Disease Control and Prevention has confirmed nine cases of Heartland virus, and one death, with other reports under investigation, said CDC entomologist Roger Nasci. Symptoms include fever, fatigue, headaches, muscle aches, diarrhea and low blood counts. Identified in Missouri, the virus also was reported in Tennessee and Oklahoma, although the Lone Star tick that spreads it lives around the East and Southeast.

Then there’s the Bourbon virus, with similar symptoms, discovered last year after the death of a Kansas man and named for his home county. Another patient, in Oklahoma, recovered. The Kansas man had found an embedded tick days before getting sick, and CDC researchers are searching for the culprit species.

HOW MANY DISEASES CAN TICKS SPREAD?

The CDC counts 14 illnesses linked to specific U.S. tick species, not including the Bourbon virus still being studied.

Lyme is the most common, with about 30,000 cases reported each year, although CDC has estimated that the true number could be 10 times higher. It’s too early to know how widespread the newly discovered illnesses are. But people can be infected with more than one tick-borne illness simultaneously, complicating care.

NO REASON TO STAY INDOORS

Health officials stress that it’s important to enjoy the outdoors and get physical activity. Infections are more common in some parts of the country than others, and there are effective protections.

“A lot of people get very concerned about any tick bite,” said Nasci, who heads CDC’s arboviral diseases branch. “Not every tick is infected.”

If you are bitten, remove the tick as soon as possible.

PREVENTION IS BEST

No matter where you live, CDC’s advice is similar.

-Shower soon after being outdoors to spot ticks more easily, and check pets that can carry ticks inside.

-If you’ve been in tick-infested areas, carefully do a full-body check, including under arms, behind knees, ears and hair.

-When in the woods, walk in the center of trails, avoiding brush and leaf litter.

-Use bug repellent with DEET on exposed skin, or wear long pants and long sleeves.

-Discourage ticks around homes by keeping grass cut; removing leaf litter and brush; and placing a barrier of wood chips or gravel between lawns and wooded areas.

5/15/15

MEDITERRANEAN DIET

If you were at my last talk you would have heard me tell you that the Mediterranean diet is basically the paleo diet, which is basically a vegetarian diet with seafood. Now there is a new study showing how the Mediterranean diet boosts your brain power. Who doesn’t need that? Remember, there is a lot of variation in what people include in the Mediterranean diet. Here they talk about unrefined grains and beans being included, which really is not paleo. It doesn’t matter. Here are some highlights if you don’t want to read the whole thing:

The Mediterranean diet, supplemented with a handful of nuts or a few tablespoons of olive oil a day, can counteract the effects of aging on the brain’s ability to function, a new clinical study suggests.

The Mediterranean diet, which has also shown benefits in cardiovascular health, emphasizes vegetables and fruits, unrefined grains and beans. It also includes fish and wine and minimal consumption of meat and full-fat dairy products.

The study involved 447 cognitively healthy participants, 55 to 80 years of age, who were divided into three groups. Two groups followed the Mediterranean diet and added either 30 grams of mixed nuts (walnuts, hazelnuts and almonds) a day, or five tablespoons of extra virgin olive oil a day. The third group, acting as a control, was advised to follow a low-fat diet. The subjects were followed for a median of just over four years.

The results showed that, compared with the control group, memory function remained stronger in the Mediterranean diet plus nuts group, while frontal (attention and executive function) and global cognition benefited in the Mediterranean diet plus olive oil group.

My take on this is that a Paleo or Mediterranean diet with it’s seafood content is critical to brain health. The reason is the Omega 3 fatty acid DHA, which is so critical. More on that in future updates.

YOU ARE WHEN YOU EAT

The Paleo Diet is just that, a diet. It is only ONE input for optimizing your health. Paleolithic men and women didn’t fly across country, didn’t have Sheetz and weren’t able to eat any food in any season. Does that matter? I think it does the author of this article. Here it is in it’s entirety. It’s worth the read:

You don’t have to be on the Paleo Diet for long to start noticing extravagantly packaged, brightly colored foods that weren’t part of our Paleolithic past. But with all the time we spend explaining that hunter-gatherers didn’t eat Big Macs and jelly beans, we sometimes forget that these foods aren’t the only unnatural consequence of our modern lifestyle. Just fly across five or six time zones to see how ill equipped your body is to handle time change. As fit as our Paleolithic ancestors were, they were never able to run quite fast enough to experience jet lag.

Our bodies are, in fact, directed by circadian rhythms that dictate when we are active, when we sleep, and even when we eat. Modern conveniences such as artificial lighting and always-within-reach snacks may disturb these rhythms placing additional evolutionary stress on our bodies that ultimately affects our diet and our health. At least this is the theory presented in a recent review published in the Proceedings of the National Academy of Science by Dr. Mark Mattson et al. These researchers proposed that our health isn’t just about what we eat, but when we eat.1

Natural 24-hour rhythms permeate the entire animal and even the vegetable kingdoms.2,3 In humans, circadian oscillations have been found in over 10% of our expressed genes affecting almost all of our bodies’ metabolic, neurological and endocrine pathways.4The suprachiasmatic nucleus (SCN) in the hypothalamus acts as our “master clock,” responding to daily light-dark cycles through photoreceptive ganglion cells in our retinas.5

In turn, our erratic eating behaviors affect our biological clocks. Two of the main pathways in our bodies that respond to fasting and feeding – cAMP response element binding protein (CREB) for fasting and the insulin-dependent mammalian target of rapamycin (MTOR) for feeding – can directly influence circadian oscillations. In one mouse study, researchers were able to use feeding to rapidly shift liver oscillations 10 hours out of sync with the light-sensitive SCN.6

This cycle of altered eating behavior and perturbed rhythms building on one another may be a major cause of obesity and metabolic disturbances.

Which raises the question, if our natural eating pattern has been altered, is the daily western habit of three square meals truly a healthy lifestyle or a consequence of disturbed rhythms? Does it actually contribute to unnecessary metabolic stress?7-10

Recent reports of hunter-gatherer eating behavior and Dr. Cordain’s own ethnographic research paint the picture of a very different eating cycle. One of hunter-gatherers consuming a single large meal in the late afternoon or evening after spending the day hunting and gathering on little to no food.11, 12 Nor did hunter-gatherers eat consistently day-to-day. While anthropological research has debunked the notion of intermittent starvation in Paleolithic times,13 without the modern joys of a stocked fridge and preservative-packed foods, hunter-gatherers likely had frequent days of severely reduced energy intake.

So if three daily large meals puts us at evolutionary odds, how should we eat?

The health benefits of a calorie restricted (CR) diet, including a positive effect on longevity, have already been established.14-17 In their review, Mattson et al. go a step further proposing two timing-dependent variations on a CR diet that are more consistent with Paleolithic behavior and may actually enhance the health benefits.18

The first is a time-restricted feeding (TRF) diet where consumption is limited to a short period during the day – a four to eight hour window – to better match life before artificial lighting. The second was intermittent energy restriction (IER) consisting of periodic days where calories are greatly reduced (i.e. just 500 calories) such as twice per week – an eating pattern that would be more consistent with a Paleolithic lifestyle. Examples of both diets are shown in the figure below:

BETTER “STRESS” MANAGEMENT

IER creates a mild stress in our bodies. But instead of being damaging, it may spark an adaptive response that ultimately enhances our defense mechanisms against more serious stress. A variety of animal studies have supported this claim showing that alternate day fasting can prevent age-related decline in the antioxidant enzymes superoxide dismutase I and catalase and can protect and even strengthen neurons against oxidative, metabolic, and proteotoxic damage.22

IMPROVED BIOENERGETIC PROFILE

A three meal-per-day paradigm has a consequence of maintaining elevated blood sugar and insulin levels both of which have been shown to have multiple health consequences including obesity, diabetes and a variety of metabolic disorders.25-28Due to extended periods of fasting, both IER and TRF diets improve metabolic profiles including lower blood concentrations of sugar, insulin and leptin, increased insulin sensitivity, better mobilization of fatty acids, and elevated ketones which can promote neuron health and protect against cancer.18, 29,30 The figure below shows improved insulin sensitivity and blood triglyceride concentrations on an IER diet over even a daily CR diet.

REDUCED INFLAMMATION

More and more research is revealing that almost all chronic diseases are linked to inflammation both locally and throughout the body. An IER diet reduces key inflammatory markers such as TNF-α and IL-6.31 However, Mattson et al. were uncertain whether the diet had a direct effect on inflammation or if it was a side effect of the weight loss typically associated with the diet.

IMPROVED REPAIR AND MAINTENANCE

Damaged organelles and misfolded proteins are a natural consequence of daily living. Fortunately our cells have mechanism, such as autophagy to take up and remove damaged cellular material. Inhibition of autophagy may accelerate aging.32Eating puts the body in a protein building mode which suppresses autophagy.33Extended periods of fasting allow our cells to switch gears and cleanse themselves.

Meal timing is a promising area of research that can bring us one step closer to eating like our Paleolithic ancestors. However, even the authors of the review pointed out that long term controlled studies are still limited and there is no consensus yet on how to best implement an IER diet. A healthy Paleo Diet should still focus primarily on what you eat. But even if you don’t want to try a timing-dependent variation, it might be worth questioning whether 9:00 pm is the best time to eat baked salmon or if you really need that big a bowl of fruit and almonds every morning.

Thanks for reading!

Trevor Connor | The Paleo DietTrevor Connor is Dr. Cordain’s last mentored graduate student and will complete his M.S. in HES and Nutrition from the Colorado State University this year and later enter the Ph.D. program. Connor was the Principle Investigator in a large case study, approximately 100 subjects, in which he and Dr. Cordain examined autoimmune patients following The Paleo Diet or Paleo-like diets.

QUICK HITTERS

Did you know that researchers found that if people are exposed to more daylight between 8 AM and 12 PM they tend to have a lower BMI (weight)? The reason? The sun synchs your internal clock and speeds up metabolism.

Boosting vitamin D decreases your risk of fatal heart attacks by 35% and cancer 14%. Supplements help but they recommend getting more SUN!!!

Alternating 30 minutes of sitting and standing each day lowers blood glucose levels by 11%

Working out later in the day (when your melatonin level is lowest) maybe the best time to workout because you are more awake. That is if you get it done by 9 PM

4/20/15

PALEO LECTURE

The updated date is May 12 at the Forest Rec Center off Thomas Jefferson Drive. The time is from 6 to 7 PM and all are welcome; even non-patients. Invite whomever you want and be there on time to get a good seat.

The study, conducted by a consortium of 26 physicians and nutrition researchers, suggests the need for a reappraisal of dietary guidelines due to the inability of current recommendations to control the epidemic of diabetes.

The authors say their review of the medical literature shows that low-carbohydrate diets reliably reduce high blood sugar — the most salient feature of diabetes — and at the same time show general benefit for risk of cardiovascular disease.

High blood sugar is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels.

During the epidemics of obesity and Type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates.

Benefits of dietary carbohydrate restriction do not require weight loss.

Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss.

Adherence to low-carbohydrate diets in people with Type 2 diabetes is at least as good as adherence to any other dietary interventions and frequently is significantly better.

Dietary total and saturated fats do not correlate with risk of cardiovascular disease.

Dietary carbohydrate restriction is the most effective method of reducing serum triglycerides and increasing high-density lipoprotein.

Patients with Type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. People with Type 1 usually require less insulin.

Intensive glucose-lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment.

“We’ve tried to present clearly the most obvious and least controversial arguments for going with carbohydrate restriction,” said Richard David Feinman, Ph.D., professor of cell biology at SUNY Downstate Medical Center and lead author of the paper. “Here we take a positive approach and look to the future, while acknowledging this paper calls for change. The low-fat paradigm, which held things back, is virtually dead as a major biological idea. Diabetes is too serious a disease for us to try to save face by holding onto ideas that fail.”

“For many people with Type 2 diabetes, low-carbohydrate diets are a real cure,” said Gower. “They no longer need drugs. They no longer have symptoms. Their blood glucose is normal, and they generally lose weight.”

For those of you reading this who are not diabetic, it doesn’t matter. You want the same benefits as diabetics get because you want to PREVENT diabetes. Capisce?

EARTHING/GROUNDING

Now for some granola stuff. I think we all know that being out in nature feels great. That is why it is sad to me that are so many people who have a nature deficiency. Think about those times you sat barefooted on the grass or lawn. What was that urge for you to pull your shoes and socks off? Weird, right? And how did you feel after being barefooted outside? I bet great. You are not going to believe this but there actually is some science to this. Here is a recent study:

Earthing (grounding) refers to bringing the body in contact with the Earth. Health benefits were previously reported, but no study exists about mood. This study was conducted to assess if Earthing improves mood. 40 adult participants were either grounded or sham-grounded (no grounding) for 1 hr. while relaxing in a comfortable recliner chair equipped with a conductive pillow, mat, and patches connecting them to the ground. This pilot project was double-blinded and the Brief Mood Introspection Scale (comprising 4 mood scales) was used. Pleasant and positive moods statistically significantly improved among grounded-but not sham-grounded-participants. It is concluded that the 1-hr. contact with the Earth improved mood more than expected by relaxation alone. More extensive studies are, therefore, warranted.

I love this because it seems right, it is a test that is very hard to fake and because there are NO side effects from doing it. I will pop some other info now and then into these health updates about grounding but until then, I highly recommend it. In fact, if you walk by my house you just may see me grounding while reading on my lawn.

Studies have shown that such light, especially from the blue part of the spectrum, inhibits the body’s production of melatonin, a hormone that helps people fall asleep. Options are growing for blocking blue light, though experts caution that few have been adequately tested for effectiveness and the best solution remains avoiding brightly lit electronics at night.

A Swiss study of 13 teenage boys, published in August in The Journal of Adolescent Health, showed that when the boys donned orange-tinted glasses, also known as blue blockers and shown to prevent melatonin suppression, in the evening for a week, they felt “significantly more sleepy” than when they wore clear glasses. The boys looked at their screens, as teenagers tend to do, for at least a few hours on average before going to bed, and were monitored in the lab.

Older adults may be less affected by blue light, experts say, since the yellowing of the lens and other changes in the aging eye filter out increasing amounts of blue light. But blue light remains a problem for most people, and an earlier study of 20 adults ages 18 to 68 found that those who wore amber-tinted glasses for three hours before bed improved their sleep quality considerably relative to a control group that wore yellow-tinted lenses, which blocked only ultraviolet light.

Devices such as smartphones and tablets are often illuminated by light-emitting diodes, or LEDs, that tend to emit more blue light than incandescent products.

Screens that are not backlit, such as some e-book readers, are preferable to typical brightly lit screens, Dr. Skene said

A 2013 study, published in the journal Current Biology, showed just how different things can be without nighttime lights: after participants had camped in the mountains for a week, their bodies began to prepare for sleep about two hours earlier than normal.

I have my orange goggles. Do I always wear them? No, I am not perfect but I am trying. Now you should too because many of you have poor sleep. Also, bad sleep also lowers your DHEA level, which I blogged about last time.

There is a massive amount of money and research going into understanding and possibly manipulating our gut bacteria. You are probably are aware of some of that now. Why? Because everybody knows how great probiotics are supposed to be for you. Probiotics have been the rage for a while but I am pretty unimpressed with how well they work. The studies just aren’t there to back up the claims.

There is up to 10 times the amount of bacteria cells in our gut then there is human cells in our body (this number is debatable). There seems to be four sections of colonies in our gut and many things affect them. The most serious one is antibiotic use. It wipes out entire sections in those colonies. Is that bad? Yes!!

Researchers at Cornell University have identified a family of microbes called Christensenellaceae that appear to help people stay lean—and having an abundance of them, or not, is strongly genetic. Mice that received transplants of the bacteria gained less weight than untreated mice eating the same diet. The study was published in the journal Cell this month.

There has been an explosion of research into how bacteria affect human health, and body weight is one of the most intriguing areas. There is growing speculation that rising rates of obesity may be due in part to increased use of antibiotics, which may be wiping out bacteria that help humans convert food into energy efficiently.

Babies are born without any bacteria and eventually play host to approximately 100 trillion of the tiny micro-organisms, which outnumber human cells by about tenfold. Bacteria coat every inch of skin, the mouth, the nose, the ears, the genitals and particularly the gastrointestinal track. They not only digest food and help fight off invaders, but also produce vitamins and chemicals that help regulate the immune system, metabolism—even mood.

This microbiome, as it is called, has evolved along with humans, and even small disruptions have been implicated in a long list of health problems, including obesity, diabetes, high blood pressure, abnormal cholesterol, belly fat, cancer and atherosclerosis, or plaque buildup in the arteries.

It has been known for decades that gut bacteria affects weight in animals. Farmers have been giving antibiotics to livestock and poultry since the 1950s because it makes them grow fatter, says Martin Blaser, a microbiologist at New York University. His studies have shown that giving low-dose penicillin to mice for just four weeks early in life makes them obese later in life—even when their gut bacteria appeared to be normal.

The Helicobacter pylori is notorious for causing peptic ulcers, but studies show that it also helps regulate ghrelin, the hormone that increases appetite. Without H. pylori to keep ghrelin in check, humans may miss the natural signals that tell them to stop eating. Yet only about 6% of U.S. children harbor the bacteria in measurable amounts.

Other studies have shown that in mice, at least, altering gut bacteria alone can change body weight, regardless of diet and exercise levels. In a study published in Science last year, researchers at Washington University in St. Louis harvested gut bacteria from four sets of identical twins in which one was lean and one was obese, and transplanted them into mice that were raised germ-free. Within weeks, the mice matched with obese donors became obese, while those with lean donors stayed lean—despite eating the same low-fat food.

“We’re finding that the microbiome is affected not just by age and antibiotics, but how many plants you eat, how much alcohol you drink, how much you exercise and how much sleep you get on average,” says microbiologist Rob Knight, the project’s co-founder.

Most microbiologists say the legions of yogurts, smoothies, supplements and other products packed with “probiotics” on the market are probably harmless, but largely untested and unregulated with little evidence to back up the claims.

So, think about the above the next time you “ask” to get a prescription for antibiotics when it is not really needed.

WHAT DO PEOPLE EAT AROUND THE WORLD?

I am very interested in how other cultures eat and also what their medical treatments are like. This article takes info from a book that photographer Peter Menzel and writer Faith D’Aluisio wrote after traveling the world for three years, visiting 80 people from incredibly diverse backgrounds to discover what they usually eat in the course of one day. For example, above is a lady from a Maasai village near Narok, Kenya who eats 800 calories day. The book is called What I Eat: Around the World in 80 Diets.

NEVER BELIEVE JUST ONE MEDICAL STUDY

Look at that chart. How crazy is that? Those dots are all over the place! This is the problem with research today. There are too many variables and not enough quality studies.

This article does a nice job trying to explain medical hype to you. With the media needing stories, each new study can get the attention it doesn’t need. Here are some excerpts from a cool article:

“There’s a big, big, difference between how the media think about news and how scientists think about news,” Naomi Oreskes, a Harvard professor of the history of science, recently told me in an interview. “For you, what makes it news is that it’s new — and that creates a bias in the media to look for brand new results. My view would be that brand new results would be the most likely to be wrong.”

As science is working itself out, we reporters and our audiences seize on “promising findings.” It’s exciting to hear about a brand new idea that maybe — just maybe — could revolutionize medicine and stop some scourge people suffer through.

We don’t wait for scientific consensus; we report a little too early, and we lead patients and policymakers down wasteful, harmful, or redundant paths that end in dashed hope and failed medicine.

This tendency could be minimized if we could only remember that the overwhelming majority of studies in medicine fail.

There have been more than 200 failures of supposed cancer breakthroughs in recent years

A highly regarded service that vets new studies for clinicians finds — on average — only 3,000 of 50,000 new journal articles published each year are well-designed and relevant enough to inform patient care. That’s 6 percent.

The truth can be found somewhere in the totality of the research, but we report on every study in isolation underneath flip-flopping headlines. (Red wine will add years to your life one week, and kill you quicker the next.)

In summary, when medical breakthroughs are concerned, don’t believe anything you see in the paper, the TV, the internet, on FB, etc. Most likely, it is just hype. Or you can bring the information to me and I will help you the best way I can.3/1/15

DHEA-S

One of the blood tests I like to draw is a DHEA-S. There are a lot of theories on what the results mean but here is a site that I think explains some of it. DHEA-S may show adrenal fatigue and a system that is just spent. This can come from age, poor sleep, too much stress, depression, etc. Restoring DHEA can be done and I have seem it do some amazing things in increasing testosterone in men (not women). It is just one indicator, though, and not a magic test or a pill. Giving DHEA is another form of giving someone a bioidentical hormone. You can take DHEA by cream or pill. I think the above link does a nice job educating the reader about DHEA but be aware, they also sell the product. I do, however, trust Life Extension supplements. That does not mean we should take everything they say at face value. Their references could all be cherry picked but I still lean towards thinking this is a pretty good test and possible supplement. Here is another site that tries to educate the reader about DHEA and the benefits to women. I really like this image explaining the pathway of how hormones are made:

You can see here that cholesterol is critical for making the sex steroid hormones (testosterone and estradiol) we need. This also shows that if your body decides to utilize the middle pathway to produce mainly cortisol you will not make much of those sex steroids. Instead it produces cortisol, which is the stress hormone. This means you are in constant fight or flight mode and you will burn out.

Testing DHEA-S is easy. The big question is whether to supplement it even if it is low? One could debate the fact that getting people OUT of the middle pathway (called the pregnenolone steal syndrome or cortisol steal syndrome) would be the best way to go. How do you do that? Well, better sleep, better sun, less stress, not eating late, meditating or spiritual work, etc all can work.

Lastly, here is one more site that describes DHEA and what it means. Jack Kruse MD is a neurosurgeon who is definitely on the fringes of medicine. That being said, I think he is brilliant BUT he can embellish a bit. I have followed him for years and have communicated with him multiple times. I believe most of what he says. I think he does a great job here explaining the problems with low DHEA and how the medical community has ignored it for too long.

I am very intrigued by DHEA and that is why I order the test. After that is when the discussion comes in. I recommend ALL OF YOU read these three links and then come talk to me or email me if you want to discuss more. If you want me to do a talk on DHEA then I can do that as well.

SUGAR ADDICTION

How addicting is the food you eat? Well, new research is showing that sugar is eight times more addictive than cocaine. Yup, that’s bad. This linked article is something you may want to read in full but it seems that pizza is the most addictive food by far due to the hidden sugar. The tomato sauce on the pizza, for example, can have more sugar than a few Oreos. Other extremely addictive foods are chips, cookies and ice cream. Cucumbers are the least addictive food, followed by carrots and beans. This is all related to how quickly it makes your blood sugar rise and the most addictive foods are the ones which are high on the glycemic index. So for those who don’t buy into the book Wheat Belly or the whole Paleo Diet philosophy, you probably should open your mind because this fits right in. From the article:

Several studies really do suggest that highly-palatable, highly-processed foods can produce behaviors and changes in the brain that one would use to diagnose an addiction, like drugs and alcohol.

When we eat wheat flour and sugar in processed foods, spikes our sugar, then insulin. Those are the hormonal disturbances that make you store belly fat, and then you are hungry for more sweets and starchy junk food.

It is these spikes and behaviors that create an endless cycle of addiction with the results being heart disease and diabetes. That is why the next section is still up. Watch the video!

2/11/15

Fun Fact #6:

I had a book published by Broadway Books a few years back. It was called the Placebo Chronicles and was basically a compilation from a magazine that I produced called the Placebo Journal. You can see copies of that on my office wall. The book is on Amazon.com but don’t buy it. I never liked it much. The magazine, though, was funny and lasted 10 years!

What is Cholesterol and is it a Scam?

The first talk at Forest DPC went really well. Thank you to those who came. It looks like that I may need a bigger venue then my office. I will try to do a talk monthly so please RSVP quickly so I can get an accurate head count next time.

For those that missed the talk, here is a brief summary. Any questions can be answered via email.

I am not an expert in cholesterol. I have, however, collated data from the best experts that I trusted and whom are not bought out. Guys like Peter Attia MD at www.eatingacademy.com. Anyone could cherry pick the evidence and make their case, however, and I think those in the corner of the old cholesterol tests are doing just that.

What I am offering you is a epidemiological look at the studies on cholesterol. There is other ways to look at this which may include putting my toe into the complementary or integrative medicine world, which I will do.

This talk is just a primer and not all inclusive. More to come on other talks.

Cholesterol is just a waxy substance that is good for you. It makes up our cell membranes, helps in steroid production, and helps in the immune system. 80% of our brain is cholesterol.

Most of the cholesterol in our body was made by our body. Eating cholesterol has very little impact on the cholesterol levels in your body. No study has ever shown that cholesterol in your diet is related to “raising” your cholesterol

The only “bad” outcome is when cholesterol ends up inside of the wall of an artery

Cholesterol doesn’t exist in our bloodstream without something to carry it from point A to point B.

The ships that take the cholesterol around are lipoproteins (like HDL and LDL) and the cargo is cholesterol and triglycerides

The normal doctors checks the lipid panel which includes total cholesterol, LDL, HDL and triglycerides. The serum cholesterol (in total) and serum triglycerides, as stated, hauls the cargo around. The old test reports HDL cholesterol as HDL-C which is the cargo on that particular ship and LDL cholesterol ,LDL-C, which is the cargo on that particular ship (actually, this is estimated). So really it is just checking the cargo and it does not check particle number. So, it only measures CHOLESTEROL MASS CONCENTRATION. In other words, the old test only conveys the mass concentration of cholesterol molecules (cargo) within all of the particle subtypes per unit of volume. The new tests (NMR Lipoprofile) counts the number of particles in each of the subtypes. Why is this important? Well, it turns out that this (counting the cargo and the ships) the most important predictor of risk.

LDL-C is only a good predictor of adverse cardiac events when it is concordant with LDL-P; otherwise it is a poor predictor of risk. So why do it?

If the recommendations are all based off of LDL-C and the old lipid panel, how can we trust the results? They are “digging in the wrong place”

It is the LDL particle number (LDL-P), on the NMR Lipoprofile, which drives the particles into the artery wall. Thus, physicians need to be able to quantify the number of LDL particles present in a given individual.They need to directly measure the number of LDL particles in your plasma using NMR technology. If this number is high, you are at risk of atherosclerosis. This comes down to a numbers game.

So, Low LDL-C doesn’t matter if LDL-P is high. You can have low or normal LDL or total cholesterol and still be at high risk from heart disease. Alternatively, you can have high or normal total or LDL cholesterol yet be at low risk. Subsequently, many are not getting enough treatment, and others are getting too much. Does having lots of HDL particles help? Probably, especially if they are “functional” at carrying out reverse cholesterol transport, but it’s not clear if it matters when LDL particle count is low.

This does not answer everything. Questions linger. Is this a problem with LDL-P or is the whole heart thing due to a inflammatory response? How do you effect the LDL-P or the inflammatory response? If you want to stop atherosclerosis, do you just need to lower the LDL particle number?

Lastly, for fun (and for a future talk):

“The epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs.” – Expert Rev Clin Pharmacol. 2015 Feb 6:1-11

SUPPLEMENTS CAN SUCK

Americans pay a lot of money for things that are not proven. I am all about supplements but I research the heck out of them and even then I am not sure I trust them. For one, we have to know that if the supplement truly has in it what it is supposed to. Turns out, most don’t!

The tests were conducted using a process called DNA barcoding, which identifies individual ingredients through a kind of “genetic fingerprinting.” The investigators tested 24 products claiming to be seven different types of herb — echinacea, garlic, gingko biloba, ginseng, saw palmetto, St. John’s wort and valerian root. All but five of the products contained DNA that was either unrecognizable or from a plant other than what the product claimed to be.

Additionally, five of the 24 contained wheat and two contained beans without identifying them on the labels — both substances are known to cause allergic reactions in some people.

Let’s say you found a company that we can all trust. The next question is whether taking a supplement is worth your money. I have some answers but not all of them. It really depends on what you are trying to help and then are you tracking your labs to show that is it working? I suspect I will need to do a talk on this.

FODMAPs and Abdominal Pain

Many patients have abdominal problems and the work up is negative. It is frustrating for both the patient and the doctor. The anti-gluten campaign conspiracy continues and though I do think there is SOMETHING to it, I still try not to make any one food evil. Interestingly enough, there is another entity called FODMAPs and it may have some validity as a cause for chronic abdominal discomfort. To read the article, click here.

There really is no secret sauce to life that I can teach. I struggle with this as well as anyone. Everyone has a lot of things to fix. I guess the word multifactorial is the best way to explain (thanks Larry) why it is so hard. All we can try to do is optimize as many things as we can and maybe this is trackable on the labs. Maybe. So what are we talking about? There is diet. There is exercise. There is stress. There are spiritual quests. There are environmental factors. And on and on. What I can offer is 20 years of experience in most of these areas and give my opinions. These opinions can and will change. Do you think I recommended a high fat, low carb diet 15 years ago? No. I was a strict vegetarian from 1989 to 2009. What does that tell you? I will, however, keep researching and learning what is the best for me and my patients.

For diet, it is the higher fat, lower carb diet. It could be called the Paleo Diet. It could be called the Spanish Ketogenic Mediterranean Diet (look at this link). In the SKMD diet they fed obese people olive oil, wine, fish and veggies and they lost tons of weight. The name doesn’t matter. The research and the results do. It is the most successful diet I have ever recommended and more than a handful of patients from Forest Direct Primary Care are kicking butt on it right now. That is why I leave the video at the bottom. It is a great primer but there are more things to fix out there. EMF. Blue Light. Nature deficiency. Environmental mismatches. Exercise. Only when these things are optimized can we talk about supplements but they will be discussed too.

Fun Secret #5

In 1999, I started a Dot Com company called Medlecture.com. This was prior to the high speed internet and people were using dial up modems. The concept was to use videos on the internet for doctors to learn and get their CME (continuing medical education). We need 50 hours a year and with this method we didn’t have to pay huge sums to go to a conference as well as leave our practice. At that time, educational video learning was not being done on the internet. Amazing, right? My vision was that people would at some point be learning online through videos so why not create it. I formed the company, found some partners and then got 7 medical schools to join on by selling us their grand round videos. We digitized their VCR tapes (yes, VCR) and made a collection of one-hour lectures in every medical specialty. We then found a tech company to create a way to enable even dial-up to watch our site clearly on the internet. Our small group then merged with a local public company to basically make Medlecture.com, well, public. I personally received 2.2 million shares. The stock price rose to $9 a share. I was rich! But wait, I couldn’t sell for 6 months. That’s okay, I thought, what could happen in 6 months? Well, we raised money ($3 million), had a massive launch party (for the cost of $250K) in New Orleans (see pic) and things were moving. The problem was that we needed another large cash infusion because money was being used up quickly. I never got paid as I figured the stock sale would be good enough. As we started another round of funding the DOT COM crash hit and the VC money dried up. We went from $9 to pennies very quickly. Ouch. Oh, and then all our money ran out. All in all, it was a great concept for which I am very proud. Sure it crushed me at that time but at least I never bought anything by banking on the money that I was going to make. Fast forward and now online learning is a billion dollar industry. Easy come. Easy go.

Light at night is bad for your health, and exposure to blue light emitted by electronics and energy-efficient lightbulbs may be especially so. Until the advent of artificial lighting, the sun was the major source of lighting, and people spent their evenings in (relative) darkness. Now, in much of the world, evenings are illuminated, and we take our easy access to all those lumens pretty much for granted. But we may be paying a price for basking in all that light. At night, light throws the body’s biological clock—the circadian rhythm—out of whack. Sleep suffers. Worse, research shows that it may contribute to the causation of cancer, diabetes, heart disease, and obesity. But not all colors of light have the same effect. Blue wavelengths—which are beneficial during daylight hours because they boost attention, reaction times, and mood—seem to be the most disruptive at night. And the proliferation of electronics with screens, as well as energy-efficient lighting, is increasing our exposure to blue wavelengths, especially after sundown.

Daily rhythms influenced by light

Everyone has slightly different circadian rhythms, but the average length is 24 and one-quarter hours. The circadian rhythm of people who stay up late is slightly longer, while the rhythms of earlier birds fall short of 24 hours. Dr. Charles Czeisler of Harvard Medical School showed, in 1981, that daylight keeps a person’s internal clock aligned with the environment.

The health risks

Study after study has linked working the night shift and exposure to light at night to several types of cancer (breast, prostate), diabetes, heart disease, and obesity. It’s not exactly clear why nighttime light exposure seems to be so bad for us. But we do know that exposure to light suppresses the secretion of melatonin, a hormone that influences circadian rhythms, and there’s some experimental evidence (it’s very preliminary) that lower melatonin levels might explain the association with cancer.

A Harvard study shed a little bit of light on the possible connection to diabetes and possibly obesity. The researchers put 10 people on a schedule that gradually shifted the timing of their circadian rhythms. Their blood sugar levels increased, throwing them into a prediabetic state, and levels of leptin, a hormone that leaves people feeling full after a meal, went down.

Even dim light can interfere with a person’s circadian rhythm and melatonin secretion. A mere eight lux—a level of brightness exceeded by most table lamps and about twice that of a night light—has an effect, notes Stephen Lockley, a Harvard sleep researcher. Light at night is part of the reason so many people don’t get enough sleep, says Lockley, and researchers have linked short sleep to increased risk for depression, as well as diabetes and cardiovascular problems.

The power of the blues

While light of any kind can suppress the secretion of melatonin, blue light does so more powerfully. Harvard researchers and their colleagues conducted an experiment comparing the effects of 6.5 hours of exposure to blue light to exposure to green light of comparable brightness. The blue light suppressed melatonin for about twice as long as the green light and shifted circadian rhythms by twice as much (3 hours vs. 1.5 hours).

In another study of blue light, researchers at the University of Toronto compared the melatonin levels of people exposed to bright indoor light who were wearing blue-light–blocking goggles to people exposed to regular dim light without wearing goggles. The fact that the levels of the hormone were about the same in the two groups strengthens the hypothesis that blue light is a potent suppressor of melatonin. It also suggests that shift workers and night owls could perhaps protect themselves if they wore eyewear that blocks blue light. Inexpensive sunglasses with orange-tinted lenses block blue light, but they also block other colors, so they’re not suitable for use indoors at night. Glasses that block out only blue light can cost up to $80.

Less-blue light

If blue light does have adverse health effects, then environmental concerns, and the quest for energy-efficient lighting, could be at odds with personal health. Those curlicue compact fluorescent lightbulbs and LED lights are much more energy-efficient than the old-fashioned incandescent lightbulbs we grew up with. But they also tend to produce more blue light.

The physics of fluorescent lights can’t be changed, but coatings inside the bulbs can be so they produce a warmer, less blue light. LED lights are more efficient than fluorescent lights, but they also produce a fair amount of light in the blue spectrum. Richard Hansler, a light researcher at John Carroll University in Cleveland, notes that ordinary incandescent lights also produce some blue light, although less than most fluorescent lightbulbs.

What you can do

Use dim red lights for night lights. Red light has the least power to shift circadian rhythm and suppress melatonin.

Avoid looking at bright screens beginning two to three hours before bed.

If you work a night shift or use a lot of electronic devices at night, consider wearing blue-blocking glasses.

Expose yourself to lots of bright light during the day, which will boost your ability to sleep at night, as well as your mood and alertness during daylight.

My advice – get blue blockers, get Just Get Flux and stop technology a few hours before bed.

COLD THERAPY

Living a life that has no environment mismatches is tough. What does that mean? That means, as shown with blue light, we should stop seeing light earlier in the winter (short light cycles) than the summer (long light cycles). Following that logic, we should be colder in the winter as well. But….we are not. In fact, we are the only mammal that gets fatter in the winter. Other animals get thinner. Technology has enabled us to heat our house, get warm cars, get warm clothes, eat out of season fruit and play Xbox or watch TV all night. This is turning out bad for us because it is fooling our chromosomes into to thinking it is summer 365 days a year and causing internal inflammation and havoc. There are ways to measure this. I do some inflammatory markers on my labs. There is also telomere testing that I will talk about some day. Anyway, it seems by fixing our environmental mismatches we can also fix our labs and ourselves. Here is an interesting article called Tapping The Power of Cold to Lose Weight. Please read as I will be expanding on this in time.

1/12/14

Fun Fact #4: I blew out my left knee in my first year in college. To make extra money, I was getting paid to run the intramural wrestling practices. While working out with some of the college students (one who didn’t know what he was doing) my knee twisted the way it shouldn’t and pop. I was never the same. Since then I have had 2 ACL reconstructions and 4 menisectomies on my left knee. It did, however, give me a great idea. While squatting to put a cover on an electrical outlet I realized that putting a towel behind my knees allowed me to stay in the squat position for a long time. And without pain! That is when I started working with foam to create pads to put on your calves when you squat. They worked great and I thought that baseball catchers would really benefit from this. Two years later I had a patent. Unfortunately, life is not that simple. It took nine years to get a breakthrough with MLB catchers. I was laughed at, ignored and ridiculed. That is until Sandy Alomar Jr needed to save his career after 5 knee surgeries. The Knee Saver worked for him and subsequently hit a tipping point in the late 90s. That is when everyone from major leaguers to little leaguers starting wearing it. It is also when 5 other companies (many who told me they had no interest in the product) decided to break my patent. I have no complaints, though. I did make some money and the first Knee Saver, worn by Sandy Alomar Jr, is in the Hall of Fame at Cooperstown.

CHOLESTEROL

I have a lot to explain to everyone about cholesterol and other things. I am using this week’s update mainly for cholesterol because it is that important and that confusing.

I have been very concerned about the overuse of statins for cholesterol. Many doctors and patients don’t even understand what cholesterol is. Did you know that the amount of cholesterol in a food has NOTHING to do with the cholesterol in your body? No study has EVER linked the two. Did you know that cholesterol is critical for our body? Not just HDL (thought of as the good one) but also LDL (thought of as the bad one). I will talk about this at another time but our brain is 70% cholesterol. We need the stuff. The problem is that when our blood gets oxidized then the LDL can get small and dense and creep into our arteries. How does our blood get oxidized? Inflammation from a high inflammatory diet (high carbs, bad fats, etc). So, LDL is really an indicator of a bad lifestyle that needs to change. That is why statins don’t do that much in preventing a heart attack in someone who has nothing else going on with them other than high cholesterol.

Here is a site call www.thennt.com. It is described as:

We are a group of physicians that have developed a framework and rating system to evaluate therapies based on their patient-important benefits and harms as well as a system to evaluate diagnostics by patient sign, symptom, lab test or study. We only use the highest quality, evidence-based studies (frequently, but not always Cochrane Reviews), and we accept no outside funding or advertisements.

Here is the information they came up with on statins, like lipitor and simvistatin. For those who don’t have heart disease and took a statin for five years:

None were helped (life saved)

1 in 60 were helped (preventing heart attack)

1 in 268 were helped (preventing stroke)

1 in 50 were harmed (develop diabetes*)

1 in 10 were harmed (muscle damage)

Think about these numbers. It takes 60 people to take this drug to help ONE person. And we cause diabetes in ONE out of 50 people taking the drug. So why are we using statins so much? I don’t know, maybe because it is easy. Just give a patient a pill and send them on their way. Then you can measure their numbers with a regular lipid profile test and say “good job”. You also get nice scores by the insurance companies for lowering people’s cholesterol, which gets you a bonus at the end of the year. All the while you have ignored the REASON for the abnormal numbers. For the doctors on the hamster wheel seeing tons of patients it is perfect. They don’t need time to explain to patients anything about cholesterol. They can prescribe drugs that don’t help and make extra money to boot. Anybody else bothered by this?

The key is to do the right test. The old lipid panel (we charge $10 but is around $70 everywhere else) is a blunt instrument that isn’t that helpful. You need a test like the NMR Lipoprofile (we charge $50 but it is up to $250 at other local clinics) that measures the amount of particles and whether they are small and dense. You also need blood tests (DHEA-S, homocysteine, hsCRP, etc) to see if your diet and lifestyle has lead to abnormal inflammatory levels on those tests. This is done at our office. More to come on this.

I am considering doing a lecture on this at the office for patients and one non-patient guest. Is there an interest out there in me doing this?

12/24/14

FUN SECRET #3

I was a Division I wrestler at UVa from 1983-1986. I grew up wrestling on Long Island. I was pretty good but I blew my knee out my first year in college. Since that time I have had 4 meniscus surgeries and 2 ACL reconstructions on my left knee. I still subconsciously limp from time to time so don’t tease me too much when you see it. My last year in college I took up boxing. My brother, Matt Farrago, was a professional at that time and ended up with a pretty good record. He now runs a retired boxing organization called Ring 10 out of NY and does great things for these down and out boxers. My history of being a boxer was brief. I actually went to the nationals in college and took 3rd (I was an All-American). That is when I traveled to Houston after college to think about turning professional like my brother. Turns out, though, I didn’t like getting hit, which was happening a lot. When I was offered to work with Mackie Shilstone (a famous sportsmedicine trainer) I took and my life went in a different direction. Probably saved a lot of brain cells in the process.

SIDE EFFECTS

Check out Iodine, the website. If you ever want to know anything about your medication and its side effects then this is it. At least from what I can tell right now. Just plug in your med and it tells you cost, reviews and the upside/downside of the drug. Supposedly, it is the Yelp of drugs. If you try it and like it please leave some feedback.

Researchers writing in the British Medical Journal examined the health claims showcased on 40 randomly selected episodes of the two most popular internationally syndicated health talk shows, The Dr Oz Show and The Doctors.

They identified 479 recommendations from The Dr Oz Show and 445 recommendations from The Doctors, finding that on average, each episode contained about a dozen bits of health wisdom.

By randomly selecting the episodes, instead of cherry picking the worst offenders, their findings give us a true picture of the quality of the health claims that are being made.

And what they found was disappointing but not exactly surprising: about half of the health recommendations had either no evidence behind them or they actually contradicted what the best-available science tells us. That means about half of what these TV doctors say to their millions of satellite patients is woo, and potentially harmful and wasteful woo at that.

FAT

Fat doesn’t make you fat….unless you mix them with carbs (sugar, fruit, grains, pasta, rice, oatmeal, etc). Try to read these articles. From the Wall Street Journal’s The Last Anti-Fat Crusaders:

The top scientist guiding the U.S. government’s nutrition recommendations made an admission last month that would surprise most Americans. Low-fat diets, Alice Lichtenstein said, are “probably not a good idea.” It was a rare public acknowledgment conceding the failure of the basic principle behind 35 years of official American nutrition advice.

People who avoid carbohydrates and eat more fat, even saturated fat, lose more body fat and have fewer cardiovascular risks than people who follow the low-fat diet that health authorities have favored for decades, a major new study shows.

12/7/14

FUN SECRET #2

I made a brief comeback training fighters in 2000. One of my best friends is Lou Savarese. I met him in 1988 and we still talk once a week to this day. He was heavyweight fighter and fought everyone (Foreman, Holyfield, Buster Douglas, and…Mike Tyson). People remember the time that Mike Tyson talked about eating Lennox Lewis’ children in an interview but don’t know when that happened. Well, I do because it was in Scotland and I was there. Lou fought Tyson and unfortunately got nailed with a shot on the top of his right temple and went down in the first round. There was a melee and confusion about whether the fight should have been stopped. The ref got between Lou and Tyson and held Lou but unfortunately Tyson still was punching Lou around the ref. I was in Lou’s corner and ran into the ring. I swear my intention was to jump on Tyson’s back. As I ran into the ring the other guys in our corner started to scream at me to get back because I would get Lou disqualified (they didn’t know that the ref already had called it). I got confused and probably chicken. After running half way cross the ring things seem to calm down so I believed the other guys in our corner were right and I was going to get Lou disqualified. So, I turned around and ran back. Don’t believe me? Check out the video at time 8:08, yelling at the ref at 8:25 and then a repeat of my entrance at 11:32. LOL.

BLUE LIGHT SPECIAL

“Light is energy, and that energy can be absorbed by melanopsin proteins that act as a switch that basically activates everything downstream,” Zoltowski said.

Read this article. We are hearing more and more about timing of light and how the wrong signals can screw us up. Right now there is no doubt that blue light affects sleep. Watch the video. It’s short.

What I am hearing/reading is that to be healthy, diet and exercise is not enough. Intuitively, we all know that. High stress in life causes problems as well so we know that things can go wrong even when we eat right and workout. Well, circadian mismatches may also be a major stressor screwing our health up. I will go into this deeper as time goes on but for now just know that if you screw with your sleep you screw with your help. And blue light screws with your sleep.

I still recommend blue blockers. You also should get this for your computer: https://justgetflux.com but don’t let that be an excuse for using your computer too late at night, however. The EMF problems also add to circadian mismatches.

MITOCHONDRIA

Remember, a couple of things. Mitochondria, the powerhouse of the cell, is our “engine”. If they work poorly then we are tired all the time. We also age quicker and then die. NAD+ may be the key. But don’t look for NAD + pill. What we need to do is find to prime the NAD+ pump. More to come, I promise.

11/25/14

FUN SECRET #1

I have a very interesting background and I will share some of these tidbits with you as we go along. Prior to medical school, I received my Master’s Degree in Education from the University of Houston. It actually was in Exercise Science but they didn’t have an official title for it at that time. Under my “testimonial” section is a quote from Jim Pivarnik PhD, who was my professor back then. He is a great guy who at one time was the president of the American College of Sports Medicine. Exercise science really is my first love. I used to train professional athletes prior to and during medical school. They were mostly boxers but there were some others as well (race car driver, tennis player, etc). I actually worked with five world boxing champions and traveled around the world for fights. Pretty cool but a lot of stress.

This is why I love Forest Direct Primary Care because we have time to talk about exercise and nutrition and I get to give you health updates regularly. Next time I will tell you about the time I was in the ring with Mike Tyson. 🙂

THANKSGIVING EATING

There is a trick to eating healthy this Thursday. The key is to stay Paleo as much as you can. Make sure you eat a higher protein breakfast that morning. Also make sure you walk or exercise that morning so you drain your muscles of stored glycogen (carbs). Eat your Thanksgiving meal with everyone else but keep the carbs lower than everyone else. Make sure your meal isn’t too late, either. Ninety minutes after eating you want to go for a long walk again. This also will help you direct your sugars towards muscle storage versus fat. Two more things. Drink lots of water. I mean lots. Do it before the big meal so you are partially filled. Lastly, do NOT eat late. Nothing after 6 pm.

BLUE BLOCKING

There is more and more information out that eating late and getting lots of blue light is bad for us. Why? Our bodies have a hormonal cascade that has to occur so that natural melatonin is produced as well as leptin is allowed to enter the hypothalamus to tell us to burn fat as heat at night. Eating late produces insulin which blocks leptin. Too much blue light also screws this up and some say adds to us getting fat. Here is recent article about blue light. Some high points from the piece:

The blue glow from televisions and other screens suppresses natural mechanisms that help us fall asleep at night, but blocking just the blue wavelength may restore normal nighttime sleepiness, according to a new study.
“The effect of screen light on the circadian physiology is particularly high in devices which are used in close distance to our eyes,” Bromundt told Reuters Health by email. “Looking at these screens in the evening can keep teenagers awake since it involves light exposure, particularly in the blue-wavelength range to which the biological clock and its associated arousal promotion has its greatest sensitivity.”
Light-emitting diode (LED) screens give off short-wavelength light, which has been shown to block a natural evening rise in the hormone melotonin that promotes sleepiness. Exposure to this blue light keeps the brain alert and “activated” when it should be slowing down to shift into sleep mode, the researchers say.
Trust me, this light issue and the EMF (electromagnetic field) issue is a deeper rabbit hole than people think. More to come.

11/14/14

Salt

The USDA, FDA and others still say salt is bad. The CDC just came out and said otherwise. Here is a small piece in the WSJ that explains the controversy some more:

We were told the science was settled. Yet new research suggests that salt is not nearly as dangerous as the government medical establishment has been proclaiming for many decades—and a low-salt diet may itself be risky. Other than how to season tonight’s dinner, perhaps there’s a lesson here about politics and the scientific method.

The USDA, Food and Drug Administration and other regulators have long instructed eaters to consume no more sodium than 2,300 milligrams a day, or about a teaspoon, well below the U.S. average of 3,400 mgs. The limits are said to reduce the risks of high blood pressure, cardiovascular disease and stroke.

But several related papers in this week’s New England Journal of Medicine undermine these recommendations, and one even speculates that the official targets pose health hazards. In one of the most complete treatments of the subject to date, researchers followed more than 100,000 people world-wide for three and a half years. They found that those who consumed fewer than 3,000 mgs had a 27% higher risk of death or a serious medical event like a heart attack.

The findings are associations, not definitive clinical proof (to the extent there is such a thing). But they add to a growing literature arguing that the evidence that sodium is harmful is weak or nonexistent, including a report last year out of the Institute of Medicine.

If the war on salt was wrongly declared, that may be because diet is inevitably an elusive and ambiguous field given the complexity of human biology. What we know about the body evolves over time. Many theories of food and health are no more than superstition, so any nutrition advice that is more specific than moderation and more vegetables ought to be taken with a grain of—well, you know.

Yet the latest USDA food pyramid, which was updated as recently as 2011, clings to simplistic low-salt pseudo-science. The FDA is pressuring food manufacturers and restaurants to remove salt from their recipes and menus, while the public health lobby is still urging the agency to go further and regulate NaCl as if it were a poison.

The larger point is that no scientific enterprise is static, and political claims that some line of inquiry is over and “settled” are usually good indications that real debate and uncertainty are aboil. In medicine in particular, the illusion that science can provide some objective answer that applies to everyone—how much salt to eat, how and how often to screen for cancer, even whom to treat with cholesterol-lowering drugs, and so on—is a special danger.

Government regulation often can lock in bad advice and practices and never changes as quickly as the evidence evolves. So be glad the salt debate continues.

Now my two cents. Maybe it isn’t the salt. Maybe it is the process food that it comes with? You know, the crappy convenience or supermarket food that comes with over 20 ingredients and full of simple carbs? Maybe, the researchers could open their eyes to that.

EXERCISE

What is below is from the blog Whole9 and is a guest post by Coach Rut who participates in the sport of weightlifting and is the current Kansas State Champion and the 2006, 2013 and 2014 National Master Champion at 94kg. There are some good tips here:

Daily Workout Structure for Optimal Results

Having spent half my life in the health, fitness and performance industry, I have observed a number of consistencies. One that constantly stands out is the lack of program structure that exists with the daily workout routine.

I’m not talking about long term training structure. That’s another story and an industrial sized can of worms.

What I’m referring to is the daily workout structure. That period of the day when we can all get in touch with our inner athlete and pump some life into our now civilized DNA.

My observation and impressions reveal that a grab bag approach to training takes place. Do a few jumping jacks, run around the block, stretch a little and then start in on whatever strikes your fancy. This leads to potential injury, poor results and most importantly it is an enormous waste of time.

The daily training structure I’ll share with you today is intended for that individual working out in his own gym. I’ll assume that if you are going to group format strength and conditioning program that you are receiving a structured approach. Let’s hope.

This daily structure has been a successful recipe for many hundreds of athletes looking to gain multiple physical qualities necessary for athletic performance and endeavors. I’ve coached these individuals in person and via other means. There are a few variations to this theme, but you should find this approach more than adequate at improving the 10 General Physical Skills outlined by Jim Cawley and popularized by CrossFit.

The Daily Workout Elements:

General Warm Up

The objective here is to elevate the core temperature and signal the nervous system of the upcoming stress. Jumping jacks, rope skipping, and jogging are good examples. Then there’s my favorite: the Concept 2 rowing ergometer.

Corrective Movements

Movements are performed to “fix” what is wrong with your mobility. This is determined via a functional movement assessment or screen (FMS). There are any number of resources for this. I’ll leave to you to track those down. This is also a good period of rehabilitative movements prescribed by a medical authority.

Strength Period

This period is dedicated to development of absolute strength. There are multiple training templates and approaches. Literally hundreds of books exist on the topic. For our purposes this is express via the ‘lift of the day’ and the rotation of total body, lower body and upper body. Incorporating the money moves like deadlift, squats, presses and if capable the olympic movements.

The Conditioning Period

This can be expressed via any number of means but should fit with your goals and objectives. In general, a mixed mode or CrossFit approach yields the best results in the shortest amount of time and is the most enjoyable. This is the period can bring out the competitor and should have an element of play and enjoyment. In my practice we prefer a maximum of 15 minutes for most conditioning designs. Combining functional movements that fit well with the strength training move of the day is something that improves with practice. Use your internet connection and GOOGLE CrossFit workouts. You’ll die before you exhaust the conditioning options.

Direct Core / Posterior Chain Work

It is the opinion of this author, that significant amounts of direct core training should be reserved for the later stages of the training day. Placing this focus in the early stages of training could pre-exhaust the midline and unnecessarily expose an athlete to injury. A well constructed program will condition the midline and (PC) but certain individuals need the additional assistance. The big three for us include RDL, Nordic Hamstrings, and Good Mornings.

Post Stretch / Myofascial Release

Time to hit the major muscle groups and the bothersome spots. Again, many books and many experts. More isn’t necessarily better. Some have taken this to an extreme and over do this period. The other fault is in taking the roller and using it as a backrest. Get your work down and get moving.

Assuming you have an hour for training the budget will look something like this:

TIME FOCUS

0-5 General Warm Up
5-10 Corrective Moves Practice
10-30 Strength Focus (Rotating Total Body,Lower Body,Upper Body)
30-45 Conditioning and/or CrossFit Mix
45-52 Direct Core
52-60 Post Stretch
This configuration should provide the structure you need to yield you 80% of your potential with a three times per week practice, but your mileage may vary.

10/21/14

Exercise

Growth hormone is the holy grail for bodybuilders and people interested in anti-aging techniques. Unfortunately, there is lack of evidence that one exercise routine or another is better to increase your own GH. From a site called simplyshredded.com: “Many gurus have suggested strange training protocols in an attempt to maximize exercise induced increases in GH or promote fasting in order to produce increases in GH. Dr. Stuart Phillips’ lab at McMaster University in Canada has demonstrated that training protocols that increase GH vs those that do not increase GH produce no difference in anabolism. This lab also showed that the exercise induced increases in GH have absolutely no statistical association with hypertrophy .” My input – No one supplement or hormone, unless in massive doses, is the answer. There is a whole cascade of hormonal interaction that needs to be optimized.

Nutrition- This is from Flex Magazine. A “muscle head publication” but those guys are usually way ahead of the medical experts due to their willingness to self experiment. Here is some good info on nuts and it works with the Paleo Diet, which I endorse. Just remember, nuts can be reallllllllly high in calories so don’t go crazy! Oh, and read this about walnuts.

Shrimp

I love shrimp and it is usually one of the healthiest foods you can eat. Falls perfectly in the Paleo or EpiPaleo Diet. That being said, this Forbes article scared the crap out of me. Read the whole thing or look below for tips:

If you buy imported shrimp, there are any number of public studies that show that the shrimp might well come from a place different from what’s listed on the package. There are a lot of problems with imported shrimp. There’s a lot of trans-shipment, there are potential drug residues or illegal chemicals in shrimp

That’s why I no longer eat shrimp in restaurants unless I’m someplace like the coast of Mississippi, Maine or South Carolina at a reputable restaurant I know has a local supplier of non-farmed shrimp. When I buy shrimp for cooking I will only buy wild caught Gulf of Mexico shrimp that comes with independent third party confirmation from a reputable group like the Marine Stewardship Council (MSC), because as the Oceana study shows, a “wild caught” label is not enough, you need this claim to be audited. I like to buy seafood at Whole Foods because they have an extremely detailed certification and traceability program which I have looked at in detail, but big box stores like BJs, Costco, and Walmart all have surprisingly elaborate certification requirements with third party verification by groups like MSC or The Sustainable Fishery Partnership.

Disease Specific

Here is a nice summary of our guidelines on sleep apnea. If you snore and you are tired then you probably need to be tested. But read the article. There are options other than the CPAP machine which is tough to get used to. These options include: lose weight, lose weight, lose weight. The mandibular device is not great. So if you need testing then talk to me at your next appointment. There are actually apps for this and other cool products on the market to make this cheaper than doing it at the hospital.

Direct Primary Care – You are now part of an exclusive “club”. Once I fill then that is it. Thank you again and hopefully I can exceed your expectations on a regular basis.

Dr. Farrago is the #1 Rated Family Doctor in Forest, Va according to RateMDs.com

QUOTES FROM PATIENTS (found on RateMDs.com)

Joining Dr. Farrago’s practice has had a major, positive health impact on me. What impresses me the most is that he isn’t a “know it all” and really is open to and keeps up on the latest developments in the field and is happy to take the time to explain them and share his opinion and recommendation. I have a great deal of confidence in him.

Now a Recommended Health Care Provider for Christian Healthcare Ministries